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Medical Fraud and Abuse

The facts that you have provided indicate extremely troubling circumstances that could seriously jeopardize the welfare of your organization. It is well-settled law that entities contracting for the services of subsidiaries are legally responsible for legal and ethical improprieties committed by those subsidiaries irrespective of whether or not the contracting organization had any specific involvement in or knowledge of those actions. Accordingly, we would strongly advise that you take immediate action to rectify the situations described in the manner outlined in our recommendations below.

Recommendations

To avoid the potentially serious criminal, civil, and financial consequences arising under MWHCs respondeat superior responsibility to prevent fraud and abuse in connection with its association with subsidiaries, it is hereby recommended that MWHC immediately:

1. Instruct the subsidiary to cease and desist from offering its contracted home health agency employees compensation of any kind in connection with client durable medical equipment (DME) orders from the subsidiary.

2. Instruct the subsidiary to cease and desist from offering financial rebates to patients who use its equipment.

3. Instruct the subsidiary either to (1) expand its payment to hospital and home health agency personnel for assisting its patients in learning how to use all types and brands of similar medical equipment, or (2) cease and desist from offering any such financial incentives in that regard.

4. Determine whether any specific individual was responsible for deliberately altering or fabricating objective medical and terminate that individual for cause.

References

Reid, T. (2009). The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. New York: Penguin Group.

USDHHS. (2004). U.S. Department of Health and Human Services-Office of Inspector

General-Statement of Organization, Functions — and Delegations of Authority.

Federal Register. Vol. 69, No. 127; July 2, 2004. Retrieved November 14, 2010,

from: http://oig.hhs.gov/organization/oigorgstatement070204.pdf

Wright State University. (2008). Boonshoft School of Medicine Policy 20:

Pharmaceutical/Medical Device Industry Conflict of Interest Policy (Adopted:

November 2008). Retrieved November.

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