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The ProviderTrust Blog

Your source for healthcare compliance news, advice from industry experts, and all things related to OIG exclusions.

Fraud and Abuse, Penalties and Fines, compliance, false claims act

Three Times is Not a Charm: Court Triples Whistleblower Damages

Posted by Michael Rosen, ESQ on Tue, Mar 21, 2017

Here is a fast moving case to watch and one that has a not so happy outcome. On March 1, 2017, a Florida federal judge awarded the U.S. and Florida governments more than $347M in trebled (three times) damages following a jury trial in a False Claims Act case. This case has many aspects that make it unique and costly, but one interesting fact is that it was a rare case in which the case went to trial and received a jury verdict of $115M in a False Claims Act case. 

The case highlights a major concern for the OIG, as outlined in the 2017 OIG Work Plan. The OIG Work Plan specifically addresses nursing home/facility fraud concerns, stating that, "Previous OIG work found that (skilled nursing facilities) are billing for higher levels of therapy that were provided or were reasonable or necessary." So the OIG proposed to and, in this case, reviewed documentation at selected skilled nursing facilities to determine it met the requirements for each particular resource utilization group. The involved sophisticated data mining and analytics, now deployed at the OIG.
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OIG Exclusion List, OIG, Fraud and Abuse, compliance, false claims act, exclusion list

Avoiding Whistleblowers- developing an effective and safe place to disclose

Posted by Mike Rosen on Tue, Sep 20, 2016

 Whistleblower

Think back to your first PE class in elementary school or your proudest moment in high school and the winning goal for that state championship game. Then, there is that dreaded whistle from the referee.  Suddenly, everything stops for the man in the stripped uniform and the power to stop everything in its tracks (the whistle). What will happen? What did he/she see that commanded a stop of the game?

Ok, now that I have your attention (and maybe that cloud nine moment in time), that whistle sometimes is not bad and signals a chance to check on a key play or issue.  This blog will address two points on whistleblowing in healthcare: (1) How to develop a safe environment for self disclosure and (2) the impact of a whistleblower action on your organization. 

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