Category Archives: Department of Justice (DOJ)

Emerging Compliance Issue: Recent False Claims Act Settlements Based on Improper Billing for Evaluation and Management Services by Physicians

An emerging health care compliance issue for hospitals and health systems is a potential liability under the Federal False Claims Act (FCA) based on billing for evaluation and management (“E & M”) services provided by employed physicians. Although potential liability for billing for E&M services (i.e., office visits) is not new, several recent FCA settlements should remind hospitals and health systems that the government may consider the submission of claims for E&M services under improper codes to result in a false claim. Continue reading

eClinicalWorks Case Raises New Questions

On May 31, 2017, the U. S. Department of Justice (DOJ) announced that eClinicalWorks (ECW) agreed to pay a $155 million settlement and enter a corporate integrity agreement with the OIG to resolve allegations that ECW caused its health care provider customers to submit false Medicare and Medicaid claims for meaningful use payments in violation of the False Claims Act (FCA). Under the corporate integrity agreement, ECW agreed to strict compliance and reporting obligations and to provide the latest version of ECW’s EHR software to each of ECW’s current customers free of charge. Continue reading

Recent False Claims Act Settlements Based on Hospital-Physician Compensation Arrangements

During the fall of 2015, the Department of Justice (DOJ) issued several press releases announcing large False Claims Act settlements based on alleged Stark Law violations related to hospital-physician compensation arrangements.  The following are three recent False Claims Act settlements involving allegations related to excessive and improper compensation arrangements between hospitals and physicians: Continue reading