Given that the Supreme Court has granted a certificate to the constitutional challenge to the PPACA by 26 states, the prospects for a number of new areas of reform – including the disclosure rules of the Sunshine Act – are uncertain. But what is more certain is that, regardless of the outcome of the debate on health rights, there is broad agreement between the parties on ongoing firm efforts to reduce health spending through the elimination of fraud, waste and abuse.  oig.hhs.gov/fraud/cia/agreements/Select_Medical_Corporation_08312011.pdf Select Medical Holdings settled a $7.5 million complaint against a former employee. The complainant had stated that Select had made clinical decisions on the length of patient stays in rehabilitation clinics, based on weekly reimbursement reports on lactation patients, regardless of medical necessity.  As part of the transaction, the company signed a five-year contract on the integrity of the business, with HHS intervening in some of the applicant`s claims.  False Claims Act Case Against Odyssey Healthcare, Inc. – About three years after our client filed a lawsuit, Bryan Dingus, a former executive director, agreed to pay $25 million to refute accusations that she filed false claims against Medicare for continuing home care services that were not provided in accordance with Medicare requirements. In addition, Odyssey has entered into a five-year enterprise integrity agreement with the U.S. Office of Health and Health Services of the Inspector General. Click here to read the U.S.
Department of Justice press release. But the DOJ also reported that its door was open to companies wishing to come forward and voluntarily report cases of fraud. The DOJ stated that it wanted to “encourage” companies to take proactive action in eliminating abuses of the federal budget and renewed its promise to make early statements and “take this disclosure into account in deciding whether or how health fraud should be accused or resolved.”  Given the trend towards individual sanctions and heavier firms, we expect that businesses will increasingly use this option in the years to come. While this creates a great opportunity for companies to act proactively in the fight against fraud, it could create additional problems for companies with inefficient compliance programs, which will remain inactive and could become bogged down in the voluntary disclosure of a competitor, supplier or customer. Gibson` Defense and Investigations Practices Group, Dunn-Crutcher LLP successfully defends companies, executives and public officials in a wide range of federal and national investigations and prosecutions and conducts sensitive internal investigations for leading companies in almost every industry. The group has members in each national registry office and relies on more than 75 lawyers with deep government experience, including many former federal and federal prosecutors, many of whom have worked at the Department of Justice and the Securities and Exchange Commission.