2022年11月16日

將代碼嵌入，複製並粘貼到您的網站或博客:司法部繼續積累醫療保健執法行動-虛假索賠，反回扣和欺詐。司法部即將迎來創紀錄的一年。在最近的一次執法行動中，電子健康記錄(“EHR”)供應商Modernizing Medicine(“ModMed”)同意支付4500萬美元，以補償AKS和《虛假申報法》(False Claims Act)的違規行為，因為他們收受賄賂以換取推薦，並導致用戶虛假報告有關聯邦激勵付款的信息。(AKS法規禁止任何人直接或間接地提供或支付任何報酬、金錢或任何其他有價值的東西，以確保醫療保險、醫療補助和其他聯邦資助項目所涵蓋的項目或服務的轉介)。ModMed通過三個營銷項目違反了《虛假申報法》:首先，ModMed向Miraca生命科學公司(以下簡稱“Miraca”)索取並收取回扣，以換取推薦和安排ModMed的用戶使用Miraca的病理服務。在2010年1月至2013年12月期間，ModMed協助Miraca向不符合AKS要求的ModMed客戶進行EHR捐贈，因為捐贈決定考慮了ModMed客戶和Miraca之間的實驗室測試或其他業務的推薦量或價值，因此不符合適用於EHR捐贈的AKS安全港例外要求，42 C.F.R.§1001.952(y)。ModMed客戶在2010年1月至2013年12月期間向Miraca提供的病理服務的聯邦醫療保健計劃提交了報銷問題索賠，並在醫療保險和醫療補助服務中心(CMS)的HHS EHR激勵計劃(“有意義使用計劃”)下提交了有意義使用激勵付款的問題索賠。其次，ModMed與Miraca合謀，不恰當地將ModMed的EHR捐贈給醫療保健提供商，以增加Miraca的實驗室訂單，並將客戶添加到ModMed的用戶群中。 In September 2013, Miraca paid ModMed an initial fee and increased transaction fees to develop and include in its EHR software, certain enhanced interface features that ModMed agreed, for a period of time, not to offer to any other pathology laboratory. Third, ModMed paid kickbacks to its current health care provider customers and other influential sources in the healthcare industry to recommend ModMed’s EHR and refer potential customers to ModMed. As a result, the United States alleges that between January 2010 and July 2017, ModMed users submitted tainted claims for incentive payments under the Meaningful Use Programs. The electronic health record industry has been the focus of False Claims Act investigations and enforcement actions. DOJ’s focus recognizes EHRs are critical to informing physician decision making and ensuring that healthcare providers select EHR technologies free from improper influence. According to DOJ, ModMed improperly generated sales for itself and for Miraca, while causing health care providers to submit false claims for reimbursement for pathology services and for incentive payments for the adoption of ModMed’s EHR system. In January 2019, Miraca agreed to pay $63.5 million to resolve allegations it violated AKS and Stark Law by providing to referring physicians subsidies for EHR systems and free or discounted technology consulting services. The False Claims Act was initiated by a qui tam relator, who received a payment of $9 million out of the $45 million settlement.