Medicare Compliance & Reimbursement

TRICARE:

MEDICARE/MEDICAID CLAIMS AREN'T THE ONLY FCA TARGETS

Health care providers should keep in mind that Medicare and Medicaid aren't the only government payers for which billing snafus could get you saddled with hefty False Claims Act fines. TRICARE, the Department of Defense's health care program for military personnel has it own set of rules, and if you run afoul of them a whistleblower could put the feds on your trail. Case in point: McKinney, TX-based device manufacturer Orthofix Inc. agreed to pay more than $1.5 million to settle allegations that it submitted false claims to TRICARE, the Department of Justice reports. Filed by former Orthofix employee Karen Neel, the suit claims that Orthofix billed TRICARE for electrical bone growth stimulation product Physiostim for use on the cervical spine. The problem: The Food and Drug Administration hasn't approved Physiostim for cervical spine treatment. The settlement represents about twice the amount of the overcharge, according to Nolan. Neel will collect 18 percent of the settlement proceeds - about $283,000 - for her role as whistleblower.
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