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Texas officials’ crackdown on FCA violations

Texas authorities will “not tolerate” healthcare providers who put personal gain over patient care according to the U.S. Attorney for the Eastern Distribution of Texas. The official made this proclamation shortly after the Department of Justice (DOJ) announced 15 physicians in Texas agreed to pay almost $3M to settle allegations they received illegal kickbacks in violation of the False Claims Act (FCA).

How do authorities find violations?

The feds can kick off an investigation for a variety of reasons, but some of the more common include:

  • Whistleblower. The government incentives those with insider information to come forward in exchange for potential financial gain. This is because the whistleblower may get a portion of the award if the information provided by the whistleblower is able to help build a successful case that results in the government recouping funds.
  • Settlement agreement. Officials can also get information if the government builds a case against other providers that results in a settlement. This is because the settlement could include an agreement to cooperate with authorities in continued investigations.
  • Red flags. The government also watches for red flags, such as claims that are not in line with peers.

These tactics work. This case alone has led to more than just the $2 million noted above. It was part of a larger claim that led the government to recoup over $32 million in funds from 33 physicians.

How can I reduce the risk of allegations of an FCA violation?

In this case the allegations stemmed from agreements with labs for testing services. The government has really cracked down on these types of arrangements. As such it is important to proactively review agreements with services from diagnostic labs to make sure they follow the FCA and other applicable regulations.

Attorney John Rivas is responsible for this communication