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Courts Examine Use of Statistical Sampling in False Claims Act Cases
By Robert James Cimasi MHA CMP™***
The False Claims Act (FCA) continues to grow in strength as the federal government and relators increase their use of the law to recover billions of dollars from companies that violate the Act’s provisions. Developments in the application and interpretation of the FCA, particularly in regard to the issue of statistical sampling in proving damages, may significantly influence the regulatory risk to healthcare enterprises, in light of the significant volume of recoveries received by the government under this law for healthcare fraud and abuse violations.
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In recent months, interpretation of the FCA influenced the outcome of two prominent healthcare fraud and abuse cases: (1) U.S. ex rel. Michaels v. Agape Senior Community (Agape), originating in the U.S. District Court for the District of South Carolina and heard by the U.S. Court of Appeals for the 4th Circuit; and, (2) U.S. ex rel. Ruckh v. Genoa Healthcare Consulting, Inc. (Genoa), in the U.S. District Court for the Middle District of Florida. The cases, both of which explored the utilization of statistical sampling in proving damages under the FCA, leave unclear the standards associated with the admissibility of expert testimony in this context.
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Assessment
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This Health Capital Topics article summarizes the Agape and Genoa cases, and discusses the role that statistical sampling may play in future FCA actions. (Read more…)
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Conclusion
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Filed under: CMP Program, Ethics, Health Insurance, Risk Management | Tagged: CMP™ Class, false claims act, Robert Cimasi |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Settlement Makes it Easier for eClinicalWorks Customers to Switch EHRs
Last week’s settlement of a False Claims Act lawsuit against eClinicalWorks makes it easier for providers to make the switch to the electronic health records system of other vendors.
The electronic health records system vendor was hit with a fine of $155 million to settle a False Claims Act lawsuit that alleged that eClinicalWorks falsely certified that the EHR met all government criteria; that the vendor failed to adequately test software before release; failed to correct critical and urgent problems and bugs for an extended period of time; failed to ensure data portability and audit log requirements; and failed to reliably record lab and diagnostic imaging orders.
Among other provisions, the settlement with the federal Department of Justice includes provisions that require the company to assist its customers in making the switch to the products of other competitors, at no charge. In the past, the charge to leave eClinicalWorks before a contract has concluded has been high, up to tens of thousands of dollars. Now, customers can get updated versions of their software free of charge, and upon request, eClinicalWorks must transfer customers’ data to another EHR vendor without penalties or service charges.
Source: Joseph Goedert, Health Data Management [6/5/17]
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FALSE CLAIMS ACT UPDATE – VALUATION FIRMS
https://www.healthcapital.com/hcc/newsletter/01_20/HTML/FCA/convert_fca_suit_hc_topics_1.22.20.php
Ann Miller RN MHA
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How to Read Healthcare Reports
Eric Bricker MD
via Ann Miller RN MHA
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