Seven Osteo Relief Institute (ORI) clinics from throughout the country have agreed to settle a Medicare fraud claim with the government. Two clinics are in Texas, one in Dallas the other San Antonio. The others are in Phoenix, Arizona, Lexington, Kentucky, Wall Township, New Jersey and Colorado Springs, Colorado. The United States Department of Justice (DOJ) states the clinics knowingly billed Medicare in violation of the False Claims Act.
What led to the investigation?
An employee from within one of the clinics filed a whistleblower lawsuit. The individual will reportedly get $857,550 of the over $7 million settlement from the DOJ.
What did the government find?
The government claims it found evidence doctors within the clinics would bill Medicare for viscosupplementation injections. The procedure involves an injection of a gel-like substance into the patient’s knee. The manufacturer of the substance claims it helps to reduce and prevent arthritis by providing lubricant to help supplement the knee joint’s natural fluid. In addition to the unnecessary injections, the clinics were also accused of providing patients with unneeded custom knee braces.
The government states the clinic’s decision to bill the government for these unnecessary services was a violation of the False Claims Act. The clinics have also entered into a Corporate Integrity Agreement with the government. The Department of Health and Human Services Office of Inspector General will monitor the agreement and help ensure the clinics implement new compliance controls to help reduce the risk of future violations. This will include reviews by an independent organization.