Recently, the Office of Inspector General for the Department of Health and Human Services (HHS OIG) unveiled its new Fraud Risk Indicator, a tool for measuring the “trustworthiness” of settling parties in False Claims Act cases involving healthcare fraud. As HHS OIG has noted, “The government’s primary civil tool for addressing healthcare fraud is the False Claims Act.”
The Fraud Risk Indicator groups settling parties into five different categories of future fraud risk: low risk, lower risk, medium risk, high risk, and highest risk. Entities in the “highest risk” category are those that have been excluded from participation in federal healthcare programs. The second highest category, “high risk”, applies when parties “pose a significant risk to the Federal healthcare program and beneficiaries.” Going forward, HHS OIG will maintain a public list of High Risk companies who have entered into a healthcare fraud settlement on or after October 1, 2018. The list can be found here.
The first two entities to appear on HHS OIG’s High Risk – Heightened Scrutiny list are ImmediaDent of Indiana, LLC and Samson Dental Partners, LLC. We wrote about ImmediaDent’s settlement in last week’s Whistleblower Roundup.
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