Tennessee Physician Agrees to Voluntary Exclusion
Effective May 31, 2016, in connection with the resolution of False Claims Act liability, Dr. Jonathan Oppenheimer, a Tennessee laboratory owner, who is also a physician, agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). Based on OIG’s investigation, it was alleged that Dr. Oppenheimer donated money towards the physician practices’ purchase of Electronic Health Records (EHR) systems in violation of the Anti-Kickback Statute and the Limitation on Certain Physician Referrals. Specifically, OIG alleged that Dr. Oppenheimer: (1) directly considered the volume and/or value of referrals and business between his laboratory and the physician practice when determining whether to make an EHR donation and the size of the EHR donation; (2) improperly considered the volume of Medicare business supplied by the physician practice when considering an EHR donation; and (3) occasionally withheld agreed-upon EHR donation payments until a certain number of cases/referrals were received from the physician practice. OIG further alleged that Dr. Oppenheimer submitted false claims to the Medicare and TRICARE programs by billing for a non-covered form of fluorescence in situ hybridization (FISH) testing. It was specifically alleged that Dr. Oppenheimer continued billing for this test despite an adverse coverage determination indicating that this form of test was experimental and, accordingly, not billable. Senior Counsel Andrea Treese Berlin represented OIG.
- Date:May 31, 2016
- CMP and Affirmative Exclusions