DOJ Announces New FCA Settlements involving Excluded Persons including a $6.5 Million Settlement involving Services Provided by a Private Duty Nurse Investigated by OIG

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The Department of Justice (DOJ) recently announced two new False Claims Act (FCA) settlements involving excluded persons. The first was a $6.5 million FCA settlement with a Nashville Home Health Agency. The services of a private duty nurse were identified in both settlement documents and the press release as an important component of the settlement. Although, the exact amount attributable to the excluded employee was not stated. In addition, it is significant that the case was investigated by the Tennessee Medicaid Fraud Unit and the Office of Inspector General (OIG). It is also significant that the settlement included State FCA violations as well as violations of the Federal FCA.

The second case is also of significant interest. In U.S. v. John Hastings, DOJ took the unusual path of filing a detailed lawsuit asserting how the defendant knowingly and intentionally skirted the exclusion rules and billed Medicare even though a settlement had already been reached by the parties. Contemporaneous with the filing of the suit, DOJ and the defendant asked the court to enter a consent judgment in which the defendant agreed to extend his exclusion and pay the government $200,000.00. This case also stands out because instead of arising out of a whistleblower suit, as most FCA cases do, this case was generated directly from an OIG investigation. This further evidences our stated view of an increasing interest in enforcement by the OIG in exclusion matters.

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Paul Weidenfeld, Co-Founder and CEO of Exclusion Screening, LLC, is the author of this article. He is a longtime health care lawyer whose practice has focused on False Claims Act cases and health care fraud matters generally. Contact Paul should you have any  questions at: pweidenfeld@exclusionscreening.com or 1-800-294-0952.

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