Bass, Berry & Sims attorney Danielle Sloane provided insight on an indictment issued by the Department of Justice that was unsealed this week related to the relationship between lab companies and rural hospitals. According to the indictment, 10 individuals were charged with conspiracy to commit fraud and money laundering for allegedly submitting fraudulent lab claims through rural hospitals that can be reimbursed at higher rates.
“This case shows not only how it hurt commercial payers and self-insured employers’ bottom lines, but also the surrounding community,” Danielle said, adding that the public health emergency highlights the importance of rural hospitals to their communities. “There is almost a heightening desire of the prosecutors to make an example of someone who took advantage of hospitals in these communities that don’t have much access to healthcare services.”
The Eliminating Kickbacks in Recovery Act (EKRA) also provides another opportunity prosecute fraud involving commercial insurers. “It is really a congressional statement that says healthcare fraud in the commercial space is not OK either—we’re not just going to watch federal programs anymore,” Danielle said.
The full article, “Investigators Target Fraud that Exploits Rural Hospitals,” was published by Modern Healthcare on July 1 and is available online (subscription required).