.avif)
Health Law Alliance is pleased to announce that a “fraud” self-disclosure filed under Anthony Mahajan’s oversight was recently accepted into OIG’s self-disclosure program, effectively limiting the provider’s liability for alleged improper billing.
OIG’s Self-Disclosure Protocol
The U.S. Department of Health and Human Services, Office of the Inspector General (OIG), encourages providers to voluntarily report self-discovered evidence of potential fraud through the Health Care Fraud Self-Disclosure Protocol.
As we have written about in detail, a discrepant PBM audit may permit providers to learn about and resolve potential liabilities to government healthcare programs through the OIG self-disclosure process. Please read our article, “PBM Audit Strategy: Potential Windows of Opportunity,” available HERE, to learn more.
In short, self-disclosure often presents an excellent opportunity for providers to limit their exposure under administrative, civil, and maybe even criminal law, but the determination whether to make such a voluntary disclosure is extremely complex and must be carefully vetted by experienced healthcare defense attorneys.
The Provider’s OIG Disclosure
Per OIG’s announcement, following a self-disclosure submitted pursuant to the Self-Disclosure Protocol, Shore Orthopaedic University Associates, P.A., Charles N. Krome, D.O., and OrthoNJ, LLC, agreed to pay $333,645.83 for allegedly submitting claims to federal health care programs using code Q4206 for the use of Fluid Flow, an amniotic fluid growth factor injection product that treats orthopedic patients, to treat conditions which were not approved by Medicare.
In short, billing Medicare for products used to treat unapproved conditions exposes a provider to significant potential consequences. In this case, the decision was made to self-disclose after extensive consideration of many factors, including the calculation of damages, minimum settlement amounts, the conduct at issue, and the potential that the disclosure would not be accepted by OIG.
HLA Specializes in OIG Self-Disclosures
At Health Law Alliance, our experienced healthcare defense attorneys are specialists in all relevant self-disclosure protocols and procedures. Indeed, our attorneys possess the background and experience necessary to provide guidance and legal advice related to self-disclosures and assist with each step of the self-disclosure process. Contact us today for a free consultation.
How to Respond to an OIG Subpoena: Defense Strategies for Healthcare Providers
Receiving an OIG subpoena means your healthcare practice is under federal investigation, typically for healthcare fraud or regulatory violations. Understanding how to respond to an OIG subpoena effectively is crucial to protecting your practice.
Read More >>Provider Alert: New York Physician Indicted in Louisiana for Virtually Prescribing Abortion Medication
New York doctor indicted in Louisiana for prescribing abortion pills via telehealth, raising legal battles over state laws, shield protections, and provider risks post-Dobbs.
Read More >>DEA Announces Three New Rules Expanding Telehealth Access
This article outlines the details of the three new telehealth rules promulgated by the Drug Enforcement Agency (DEA) and their impact on telehealth providers.
Read More >>Remote Patient Monitoring: Know the Basics of Compliant Billing and Coding
In the article we outline the basics of RPM billing and coding, including which RPM services are billable by payor, the unique fraud risks associated with RPM, and best practices for providers to ensure their billing/coding procedures for RPM services are legally compliant.
Read More >>