Nephrology and Dialysis Practices
JULY 13, 2022
DOJ files civil complaint alleging Fresenius performed unnecessary procedures on dialysis patients
In June, it was revealed that DOJ would partially join a whistleblower lawsuit against the dialysis provider. In a civil complaint filed July 12, the department alleges Fresenius subsidiary Azura Vascular Care of violating the False Claims Act by performing medically unnecessary procedures on dialysis patients at nine locations in NY. The complaint claims the company incentivized employees to perform the surgeries to increase its own profits despite not providing any health benefit to the patients. As well, the DOJ believes Fresenius falsified medical records to make it appear as though the patients were referred for the procedures.
SOURCE: The United States Department of Justice
JULY 27, 2022
In a motion filed in the U.S. District Court for the Northern District of Illinois, DOJ outlined a no-poach case resolved in favor of McDonald's has no bearing on civil litigation for similar allegations against DaVita and other healthcare providers. According to the federal government, the distinction is that the arrangement restricting worker recruitment at McDonald's is vertical, as it involved franchisees. However, DOJ considers the agreements in the DaVita case as horizontal as it involved direct competitors for labor. DaVita was cleared in a criminal no-poach trial but is facing a civil suit from former employees.
SOURCE: Law360 (sub. rec.)
JULY 20, 2022
DOJ makes 36 arrests in billion-dollar fraud scheme
DOJ says the alleged scheme involves telemedicine, cardiovascular and cancer genetic testing and durable medical equipment. In connection with the enforcement action, the department seized over $8 million in cash, luxury vehicles and other fraud proceeds. The CMS' Center for Program Integrity also took administrative action against 52 providers involved in similar schemes. DOJ states the plot involved payment of illegal kickbacks and bribes by lab owners and operators in exchange for patient referrals from medical professionals by fraudulent telemedicine and digital medical technology companies. The telemedicine part of the scheme accounted for $1 billion of the total.
SOURCE: The United States Department of Justice
JULY 1, 2022
DaVita CEO calls SCOTUS interpretation 'too narrow' in decision on dialysis reimbursements
Javier Rodriguez contends SCOTUS acknowledged the Medicare Secondary Payer Act (MSPA) is designed to prevent private plans from pushing members onto Medicare by offering lower benefits than those already on the public plan. While the justices' ruling doesn't undermine the principle of same coverage for everyone, he says, it may set a precedent whereby plan sponsors opt to offer all employees limited benefits for outpatient dialysis so that they do migrate to Medicare. Rodriguez states the ruling's timing may be too late to affect benefits' plans up for renewal in 2023 but by 2024, the full impact should be known. He adds that every shift of 10% of outpatient dialysis to Medicare fee for service equates to $20 million in operating income.
SOURCE: Healio (sub. rec.)
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