Bass, Berry & Sims attorneys Denise Barnes, Emily Fountain and Ben Schrader authored an article for Law360 analyzing a recent $95 million wound care fraud prosecution and what it reveals about the U.S. Department of Justice’s (DOJ) evolving enforcement efforts in the wound care industry.
The attorneys explained that the case demonstrates the DOJ’s increasing focus on both medical necessity and financial relationships surrounding wound care products including rebates, discounts and potential Anti-Kickback Statute concerns. They noted that recent prosecutions suggest regulators are scrutinizing all participants across the wound care supply chain, from manufacturers and distributors to providers and marketers.
“The larger lesson is that the DOJ appears interested in the entire transaction: who identified the patient, who recommended and selected the product, what the provider paid, what discounts or rebates were received, how sales personnel were compensated, what the medical record showed, and what was ultimately billed to Medicare,” the authors noted.
According to the attorneys, healthcare organizations should evaluate Anti-Kickback Statute compliance alongside reimbursement practices, product selection decisions and relationships with distributors and marketers as enforcement efforts become increasingly data-driven and comprehensive.
The full article, “$95M Nev. Case Provides Clues On Wound Care Enforcement,” was published September 29 by Law360 and is available online (subscription required).