What should know about CMS and DOJ are scrutinizing medicare billings for amniotic injections?

 The False Claims Act establishes both civil and criminal penalties for violations. The federal health care fraud statute, 18 U.S.C. Section 1347, also imposes criminal penalties for fraudulently billing Medicare. Under the False Claims Act and the federal health care fraud statute, evidence of knowledge or intent is required in order to substantiate criminal charges. However, providers can face civil penalties under the False Claims Act for inadvertent billing mistakes—including mistakes that result from unfamiliarity with the pertinent Medicare billing rules and regulations. Civil penalties under the False Claims Act can include recoupments, treble damages, fines, other forms of financial liability, and Medicare exclusion. In criminal health care fraud cases, providers can face financial liability and federal imprisonment.

CMS and the DOJ are also using audits and CIDs to target providers for violations of the Anti-Kickback Statute (AKS) and Eliminating Kickbacks in Recovery Act (EKRA) in relation to amniotic injections. These statutes prohibit health care providers from offering, paying, accepting, or receiving any prohibited form of “remuneration” for referrals of Medicare beneficiaries. They also prohibit payment of compensation for using or promoting particular services covered by Medicare.

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