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Catch of the Week: Moffitt Cancer Center

Posted  January 5, 2024

This week’s Department of Justice (DOJ) Catch of the Week goes to Tampa-based H. Lee Moffitt Cancer Center & Research Institute Hospital.  Yesterday (January 4), the non-profit cancer treatment and research center agreed to pay roughly $19.6 million to settle DOJ charges of violating the False Claims Act by billing Medicare for patient care services provided during research studies not eligible for reimbursement.

Specifically, the government alleged that from 2014 to 2020, Moffitt billed Medicare and other federal healthcare programs for services not covered by CMS rules governing reimbursement for care provided in connection with clinical research trials.  According to the government, Moffitt violated these rules by improperly billing for items and services provided as part of clinical trial research that should have been billed to non-government trial sponsors.

In announcing the settlement, the government stressed how important it is for healthcare companies conducting federally-funded research to comply with the government’s reimbursement rules.  As Acting Special Agent Fernando Porras of the HHS Office of Inspector General put it, “providers participating in clinical trials funded by federal health care programs must abide by specific guidelines that safeguard these programs,” and “will be held accountable if they bill for services outside the rules governing reimbursement.”

The government also highlighted the importance of promptly reporting any violations of these rules once the company discovers them.  That is what Moffitt did here and DOJ went out of its way to recognize the company for that proactive effort:

When those who receive funds from government healthcare programs discover that they have submitted improper claims, we encourage them to promptly disclose the issues and cooperate fully with investigators to reach an appropriate and swift settlement.  That’s what Moffitt did here: self-reported its improper claims, cooperated with government investigators and took action to remediate its billing systems.

DOJ specifically noted that once Moffitt learned of the violations it initiated an independent investigation and compliance review and voluntarily provided the government with a written disclosure of its findings.  DOJ concluded that “Moffitt cooperated fully with the government’s investigation of the conduct and implemented prompt and substantial remedial measures.”  Clearly, the $19.6 million payout would have been significantly higher but for Moffitt’s cooperation.

This provides a very good lesson for companies and their compliance departments when they learn of fraud or misconduct within their organization.  And an especially good lesson on the importance of providing a safe and confidential channel for whistleblowers to report wrongdoing internally.

We do not know if a whistleblower was involved in alerting Moffitt to its violations.  But we do know from our own experience that whistleblowers almost always raise their concerns internally.  It is only after they have been ignored, rebuffed, and most commonly, met with job-ending retaliation that they reach out to us to file a False Claims Act case or otherwise seek legal assistance and guidance in approaching the government about the misconduct.  That leads to a whole lot more trouble for the company than if they had taken the whistleblower’s concerns seriously.

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Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Facility, Medical Billing Fraud, Medicare,