On the one hand, the hospital`s agreement with the U.S. Department of Justice does not require a company agreement (CIA), which could have led to years of incriminating surveillance. But the hospital did not escape unscathed. The UMDNJ has agreed to pay US$2 million to the federal government to clarify allegations that they defrauded Medicaid, according to a recently announced settlement by the US Department of Justice in Washington, DC. UMDNJ had already paid $US 4.9 million to the State of New Jersey to settle a criminal complaint for double billing. The state then returned half of that money to the federal Medicaid program. The additional $2 million settlement will end the federal government`s attempt to recover money it believed it had received illegally, said Tony West, JD, deputy attorney general of the Justice Department`s Civil Division in Washington, D.C. “This settlement is expected to have little impact on the UMDNJ, other than the payment of the $2 million. However, there may be other investigations that we are not aware of. Regulations on fraud and abuse in the healthcare sector continue to be implemented at record speed, and there is no indication that things will slow down in the near future. Healthcare compliance officers play a crucial role in informing their organizations` executives and boards of directors about the risks that they are not complying with all the confusing rules and regulations in today`s market.
Failure to comply may result in fines and penalties related to STARK II regulations, federal anti-kickback law, False Claims Act, and other warrants. Another aspect of the government`s response to the non-compliant behavior and action of an identified supplier is the establishment of a corporate agreement (CIA) between the supplier and the U.S. Department of Health`s (HHS) Office of inspector general (OIG) as a framework for a trial period. In an unprecedented deal, UMDNJ reached an agreement in 2005 with Christie to evade prosecution by allowing a federal observer to oversee the university for two years. “Today`s agreement shows that the Department of Justice will not tolerate fraud in our Medicaid programs created to serve our country`s low-income families, children, and seniors,” West says. “We will continue to work with our partners in the Office of the Inspector General of the Ministry of Health and Human Services to protect the integrity of our public health programs.” As part of a 51-line deal, UMDNJ said it would appoint a compliance officer, set new guidelines and train staff on anti-kickback legislation. The university also agreed to authorize the federal government to conduct on-site inspections and verify its books, financial documents and other records. “Rutgers is pleased that the five-year corporate agreement, which was entered into by the Office of Inspector General of U.S. Department of Health and Human Services and the former New Jersey University of Medicine and Dentitry, has been signed,” said Greg Trevor, a rutgers spokesman.
“Rutgers has worked with the federal government to continue the compliance program established under the agreement.” In December 2005, UMDNJ entered into a deferred Prosecution Agreement (DPA) with the DOJ, which expired in December 20073. This UMDNJ DOJ study in 2005 also revealed several other areas of abuse, including in the cardiology transfer program that resulted in the recent agreement.4 “I have received training in compliance requirements and responsibilities and understand that they refer to (name of department), an area under my supervision…
