Medicare Compliance & Reimbursement
Your Trading Partners' Help Could Backfire
The feds' undercover probe into durable medical equipment fraud - called "Operation Headwaters" - reeled in sizable settlements from the enteral nutrition industry Feb. 11.
OPI Properties, Inc., a subsidiary of drugmaker Novartis Corporation, pled guilty to nine felony counts of obstructing a federal audit. OPI agreed to five years' probation and a criminal fine of $4.5 million.
U.S. Attorney for the southern district of Illinois Ronald J. Tenpas also announced a $45 million civil settlement agreement with OPI and Novartis Nutrition Company (NNC) - another Novartis subsidiary - on related allegations.
OPI admitted that it shipped numerous free enteral nutrition pumps to undercover DME supplier Southern Medical Distributors. OPI intended to exchange lucrative Medicare reimbursement for SMD's agreement to buy more products from OPI, Tenpas said.
OPI also reportedly offered SMD an up-front $20,000 "conversion bonus." The money locked SMD into buying $1.2 million worth of enteral products for Medicare beneficiaries over a three-year period, prosecutors say.
For its role in the scheme, OPI will be permanently excluded from Medicare.
Medicare Compliance & Reimbursement
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Your Trading Partners' Help Could Backfire
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