Healthcare Regulatory Check-up | November 2022

• Published date: 15 December 2022
• Subject Matter: Food, Drugs, Healthcare, Life Sciences, Food and Drugs Law
• Law Firm: McDermott Will & Emery
• Author: Tony Maida, Emily Jane Cook, Monica Wallace, James A. Cannatti III, Mackenzie Badger and Taylor Edward Hood

This issue of McDermott's Healthcare Regulatory Check-Up highlights significant regulatory activity between October 21 and November 18, 2022, including recent enforcement activity, new litigation associated with the Office of Inspector General (OIG) Advisory Opinion No. 22-19, and a series of final Medicare payment rules from the Centers for Medicare & Medicaid Services (CMS)

NOTABLE ENFORCEMENT RESOLUTIONS AND ACTIVITY

PRIMARY CARE OWNER SETTLES FCA ALLEGATIONS FOR $2.6M

Feel Well Health Center, a primary care practice, and its physician owner entered into a civil settlement agreement and paid $2.6 million to resolve allegations that they violated the federal False Claims Act (FCA) and the state false claims act by improperly billing Medicare, Connecticut Medicaid and the State of Connecticut Comptroller Healthcare Programs by submitting false claims for payment for medical visits when, in fact, the patients had received fitness- related services with no legitimate medical component at a gym operated and staffed by a medically unlicensed coach and yoga instructor. The government also alleged that Feel Well and its owner submitted false claims for services allegedly rendered by its owner in an office setting when he was not physically present in the office suite, including when he was out of the country, on vacation or in a different office at the time. In connection with the civil settlement, Feel Well also entered into a three-year corporate integrity agreement with US Department of Health and Human Services (HHS).

OUTPATIENT SUBSTANCE-USE TREATMENT CENTER OWNER SENTENCED TO SIX YEARS IN PRISON

An Ohio-based substance-use treatment center owner was sentenced to six years in prison and ordered to pay $1.57 million in restitution to the Ohio Department of Medicaid's benefits program after pleading guilty to one count of aggravated theft and one count of Medicaid fraud. Ohio investigators found that the owner had submitted approximately 5,000 claims for services that were not provided, including claims for services purported to be personally provided while the owner was out of the state.

DOCTOR PLEADS GUILTY TO PSYCHOTHERPAY FRAUD SCHEME

A Connecticut-based physician and owner of MDCareNow LLC waived his right to be indicted and pleaded guilty to one count of healthcare fraud and one count of kickbacks involving federal healthcare programs in connection with his submission of fraudulent claims for psychotherapy services. MDCareNow and its physician owner...