Signing a Settlement With OIG Won’t Spell the End of a Doctor’s Legal Worries

December 8, 2014
Medical Practice Compliance Alert

William Maruca was quoted in the Medical Practice Compliance Alert, “Signing a Settlement With OIG Won’t Spell the End of a Doctor’s Legal Worries.” Full text can be found in the December 8, 2014, issue, but a synopsis is below.

The settlement between Office of Inspector General (OIG) and Arrowhead Cardiology Medical Group in Colton, Calif., shows that self-disclosure does not protect a company from lofty financial penalties. The practice will pay $485,217 over the next two years for submitting claims for more than one ECG (93042) per patient per day “when there was no documented change in the patient’s condition to warrant an additional service.”

The settlement will likely specify that the doctor may be subject to claims from the Internal Revenue Service (IRS), exclusion from Medicare and other government programs and criminal prosecu¬tion. That is all standard, says William Maruca, partner, Fox Rothschild, Pittsburgh. “The OIG does not have the legal authority to release a party from potential criminal liability, and they will not guarantee a party will not be excluded [which falls within CMS’s authority].”

This pending agreement also demonstrates that providers can expect to make detailed financial disclosures to OIG that will potentially lead to further legal action. “In some cases, these claims are settled on the basis of the defendant’s ability to pay, and that requires financial disclosures,” Maruca says. “If their certifications are inaccurate, there is an additional penalty equal to any undisclosed assets [or the feds can rescind the settlement and file suit]. If a practice hides or misrepresents assets as part of those discussions, you can certainly expect the government to come down hard.”