The Regulator

One filing now earns a company credit under two federal fraud-disclosure programs, under a policy the Justice Department and the HHS Office of Inspector General (OIG) announced October 15. A company that voluntarily discloses possible criminal health care conduct to the Justice Department’s National Fraud Enforcement Division gets the benefits of both the department’s Corporate Enforcement Policy and OIG’s Health Care Fraud Self-Disclosure Protocol, with no separate OIG filing. The flip side: OIG updated its protocol to say criminal matters belong at the Justice Department, and a company that discloses only to OIG generally will not have made a voluntary self-disclosure to the department and generally will not qualify for a declination (a decision not to prosecute) on that basis. The Justice Department’s examples include illegal kickbacks and billing Medicare for medically unnecessary services. Officials tie the benefits to a company that “cooperates fully, and remedies the misconduct,” and say one that “conceals what it knows” should expect a very different outcome. Who it hits: hospital systems, labs, device makers, pharmacies and any provider whose compliance team finds a problem and must decide where to report it first. The release states no dollar figure or deadline, and we could not review the full policy PDFs, only the press release. This is a Thursday announcement; it leads a quiet weekend because nothing newer from a primary source cleared our review. Confidence: High on the provisions in the press release; Low on how the policy is applied in practice. Sources: Justice Department press release, October 15, HHS-OIG enforcement listing.

A Kansas health care software company owner was sentenced to 19 years in prison for a scheme that billed Medicare and other federal programs more than $1 billion. HHS-OIG’s enforcement page, dated October 15, says the sentencing occurred the day before and that his internet platform generated false doctors’ orders and prescriptions. HealthExec reports the defendant is Brett Blackman, CEO of HealthSplash, whose orders went to telemedicine doctors who signed them in exchange for kickbacks, that the government was billed for largely unnecessary equipment such as power wheelchairs, and that a jury convicted him in April. OIG’s page does not name him, the company or the court, and states no restitution amount, so the name and scheme details rest on trade reporting; we could not reach the Justice Department release. Who it hits: telemedicine platforms and durable medical equipment suppliers, the two segments this kind of order-generation scheme runs through. Confidence: High on the 19-year sentence and the $1 billion figure (OIG); Med on the name and scheme details (HealthExec). Sources: HHS-OIG enforcement action, October 15, supplemental: HealthExec.