Health Law Alliance, led by Anthony Mahajan, announces the acceptance of a self-disclosure by OIG on behalf of Shore Orthopaedic University Associates, limiting liability to $333,645.83 for Medicare claims involving an unapproved code for Fluid Flow. The success underscores Health Law Alliance's expertise in OIG self-disclosures and the intricate decision-making process surrounding voluntary disclosures.

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.

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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.

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