Description: Oklahoma City, Oklahoma criminal defense lawyer represented defendant charged with violating the False Claims Act by submitting false claims to Medicare.

OHHS is an Oklahoma limited liability company that owns and operates the Oklahoma Heart Hospital South, which is an acute care hospital located in Oklahoma City. Following an internal review and audit, OHHS discovered irregularities regarding its billing of certain services, and proactively contacted the United States to self-disclose the issues. Thereafter, the United States investigated the disclosures and issues raised by OHHS. Throughout the investigation, and to its credit, OHHS cooperated with the United States Attorney’s Office and the U.S. Department of Health and Human Services Office of Inspector General in the investigation.

The voluntary disclosure and investigation revealed that from June 1, 2013, through May 31, 2019, OHHS submitted claims to Medicare for Intensive Cardiac Rehabilitation ("ICR") services provided to Medicare beneficiaries. Before billing Medicare for these services, OHHS was required to have a physician complete and sign an individualized treatment plan ("ITP") for the patient. If the patient was going to receive ICR for longer than 30 days, a physician must complete and sign updates to the ITP every 30 days thereafter. The United States alleges that claims for ICR services submitted by OHHS to Medicare for payment violated the False Claims Act because a physician did not complete and/or sign ITPs and/or ITP updates for certain Medicare beneficiaries.

To resolve the claims, OHHS agreed to pay $1,151,770.50 to the United States. In reaching this settlement, OHHS did not admit liability, and the government did not make any concessions about the legitimacy of the claims. The agreement allows the parties to avoid the delay, expense, inconvenience, and uncertainty involved in litigating the case.

This case was investigated by U.S. Department of Health and Human Services, Office of Inspector General. Assistant U.S. Attorneys Ronald R. Gallegos and Scott Maule prosecuted the case.

Outcome: Settled for $1.151 million.

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