Bradley attorney Jason Mehta was quoted in Part B News on recent Department of Justice memos that may affect the high number of False Claims Act (FCA) settlements. In 2017, DOJ collected more than $3.7 billion from FCA cases — $2.4 billion of which “involved the health care industry, including drug companies, hospitals, pharmacies, laboratories and physicians,” the DOJ reports.
Experts don’t expect that to slow soon. “I think there has been an uptick in the past few years in the amount of energy and resource DOJ has put into prosecuting health care fraud criminally and civilly,” said Mehta. While multimillion-dollar cases of obvious fraud get most of the publicity, there are plenty of smaller cases in which “well meaning institutions [that] through lack of diligence were submitting upcoded claims” get in trouble too, explained Mehta, who said he “had several cases” like those while he was a federal prosecutor.
Among the targets, said Mehta: “pain management clinics, for example, who billed every patient for a toxicology test —yet still prescribed opioids to those patients. Why are we testing, quantifying them, yet never changing prescription habits?” Also, orthopedic groups whose “MRI [ordering] doesn’t add up with their peers in the market.”
In addition to those data-driven actions, there’s also the threat of qui tam suits — “when a whistleblower is trying to capture overpayments by categorizing them as false claims, to extrapolate that into an intentional fraud case,” said Mehta.
The complete article, “DOJ memos reduce danger of FCA prosecutions – but watch for this hidden threat,” appeared in Part B News on March 19, 2018.