The Department of Justice recently reached a settlement of $7.13 million with seven Osteo Relief Institutes (“ORI”) for fraudulent Medicare billing related to unnecessary medical treatments and equipment. The allegations of the fraudulent billing by the ORI’s were brought to light in part by the filing of a qui tam lawsuit under the False Claims Act (“FCA”) by a whistleblower who will receive $857,550 from the settlement.
At the heart of the lawsuit were allegations which revolved around wrongful Medicare billing by the ORIs for viscosupplementation injections. These procedures involve the injection of a lubricative fluid into a patient’s knee with the intent to provide osteoarthritis relief. However, the whistleblower alleged that the ORI’s performed a whole host of impermissible actions with the injections. The impermissible activities included giving them to Medicare patients who did not require them, repeatedly injecting patients with different brands of injection fluid without clinical support and using reimported discount brands of the injection fluid. Separate from the injections, the whistleblower also alleged that the ORI’s supplied unnecessary knee braces to patients. Allegedly, the ORI’s, in violation of federal regulations, then fraudulently billed Medicare for all of these services.
In addition to the monetary settlement, the settling ORI’s have also signed a Corporate Integrity Agreement with the United States Department of Health and Human Services Office of Inspector General. This agreement will require them to implement procedures and controls to prevent any such fraud from occurring again and subjects the ORI’s to annual reviews of future Medicare claims.
The whistleblower who filed the FCA qui tam lawsuit, thus initiating the investigation into the ORI’s possible Medicare fraud, played a crucial role. The end result of Medicare billing for unnecessary procedures, like the injections in this case, is for taxpayer dollars, which have been earmarked to provide healthcare for some of the country’s most susceptible population segments, to instead line the pockets of fraudsters. Further, subjecting patients to unnecessary and clinically unsupported procedures opens those patients up to a multitude of risks and potential complications. By taking action and exposing the alleged misconduct by the ORI’s, the whistleblower here once again proved the efficacy of the FCA in stopping fraud against the federal government, and ultimately, against the taxpayers of the United States.
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