For hospitals, health systems, and physician practices under government scrutiny over procedure billing, a deferred prosecution agreement can resolve criminal charges without a guilty plea.
The terms, however, can include restitution, an independent monitor, and compensation funds that reshape how an organization oversees its clinical and billing operations.
In a recent article, “Hospital Enters ‘Tentative’ DPA With DOJ Over Billing for Surgeries,” Report on Medicare Compliance examined a proposed agreement between a Virginia hospital and the Department of Justice. (Download the edition in PDF format.)
The case centers on a physician’s allegedly unnecessary surgeries. Melissa L. Jampol, Member of the Firm of Epstein Becker Green and counsel to health care organizations on government investigations, health care fraud, and False Claims Act matters, discussed what the agreement would require and why it remains unsettled.
The proposed agreement would require the hospital to pay $6.4 million in restitution to government and private payers, retain an independent monitor, and fund a $12.8 million pool for affected patients. Charges would be dropped if the hospital complies. Before the agreement is finalized, however, victims are being invited to comment, and their input could change its terms or stop it altogether.
Jampol noted that the agreement would also spare victims from testifying at trial. For a case that has stretched on for years, she sees a different kind of value in that outcome.
“It gives finality to this case that has been going on for a really long time,” Jampol said.
Get in Touch
To discuss how a government investigation or resolution agreement may affect your organization’s billing practices and compliance obligations, contact Melissa L. Jampol at mjampol@ebglaw.com.
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