What's worse than one False Claims Act settlement? How about two False Claim Act settlements?
“Specifically," says the DONJ release, "the United States alleged that, from January 1, 2012, through June 30, 2017, Healogics submitted claims to Medicare, Medicaid, and Tricare using modifier 25 to signify that a separate evaluation and management service was performed on the same date as another procedure when no such separate service was performed.”
The second, much more expensive settlement began as two qui tam cases brought by four individuals: a former employee director for research and quality affairs for Healogics, and two doctors and a program director who worked at wound care centers affiliated with Healogics. “The settlement provides for a whistleblower share of up to $4,276,900,” the USAO for the Middle District of Florida announced in its press release.
And this might not be the last time Healogics writes a check to the government. “The provider agreed to pay an additional $5.01 million if certain financial contingencies occur within the next five years, for a total potential payment of up to $22.51 million.”
The press release doesn’t provide any details about the financial contingencies, but they may be contained in the yet-to-be-posted corporate integrity agreement that Healogics entered into with the HHS Office of Inspector General.