"Medicare beneficiaries are entitled to care based on their clinical needs and not the financial goals of healthcare providers," said Acting Assistant Attorney General Chad A. Readler for the Justice Department's Civil Division. "All providers of taxpayer-funded federal healthcare services, whether contractors or direct billers, will be held accountable when their actions knowingly cause false claims for medically unnecessary services to be submitted."
Medicare covers HBO therapy, a modality in which the entire body is exposed to oxygen under increased atmospheric pressure, as an adjunctive therapy to treat certain chronic wounds. The settlement announced today resolves allegations that from 2010 through 2015, Healogics knowingly submitted or caused the submission of false claims to Medicare for medically unnecessary or unreasonable HBO therapy.
Under the settlement, Healogics has agreed to pay $17.5 million, plus 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.
"Civil healthcare fraud enforcement has always been a core part of the mission of our office," said United States Attorney Maria Chapa Lopez for the Middle District of Florida. "With this settlement, our Civil Division confirms its commitment to our nation's critical struggle against practices that put public health programs at risk."
In addition to resolving its False Claims Act liability, Healogics has entered into a five-year Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General which includes, among other things, a claims review and a systems review - both to be conducted by an Independent Review Organization.
"When greed is the primary factor in performing medically unnecessary health care procedures on Medicare beneficiaries, both patient well-being and taxpayer funds are compromised," said Special Agent in Charge Shimon R. Richmond of HHS OIG. "We will continue to thoroughly investigate health care companies that engage in such fraudulent schemes."
The allegations resolved by this settlement arose from a lawsuit filed by James Wilcox, a former Director for Research and Quality for Medical Affairs at Healogics, and a separate lawsuit filed by Dr. Benjamin Van Raalte, Dr. Michael Cascio, and John Murtaugh, two doctors and a former program director who worked at Healogics-affiliated wound care centers. The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery. The settlement provides for a whistleblower share of up to $4,276,900.
The settlement was the result of a coordinated effort by the Civil Division's Commercial Litigation Branch, the United States Attorney's Office for the Middle District of Florida, and the Department of Health and Human Services Office of Inspector General. The case was handled by Assistant United States Attorneys Randy Harwell and Jeremy Bloor, and by Department of Justice Civil Division Trial Attorney Chartey Quarcoo.
The cases are captioned United States ex rel. Van Raalte, et al. v. Healogics, Inc., 14-cv-283 (M.D. Fla.) and United States ex rel. Wilcox. v. Healogics, Inc., et al., 15-cv-1510 (M.D. Fla.).
The claims settled by this agreement are allegations only, and there has been no determination of liability.