Judith Waltz on CMS Open Payments Case – 'Plea takes compliance to whole new level'

Foley & Lardner LLP partner Judith Waltz commented in the Report on Medicare Compliance article, “In Guilty Plea Over CMS Open Payments Program, Physician Admits to False Statements.”

Waltz, chair of Foley’s national Health Care Practice, shared insight on the risks of noncompliance with the Open Payments Program, which requires pharmaceutical and device manufacturers and group purchasing organizations to disclose transfers of value to the Centers for Medicare and Medicaid Services (CMS).

“This plea takes compliance with the Open Payments Program to a whole new level,” Waltz said of the criminal charges highlighted in the article. “It’s an additional risk with Open Payments.”

While Waltz noted that while it is unclear if a provider who pleads guilty to false statements would face exclusion from federal health care programs and/or revocation of their Medicare billing privileges, it is a possibility. The Office of Inspector General is required to exclude providers who are convicted of violating the Anti-Kickback Statute (AKS), she explained, though this case did not result in an AKS conviction.

“Similarly, CMS can deny or revoke billing privileges for up to ten years for a provider, supplier, or any owner, managing employee, managing organization, officer, or director of the provider or supplier that is convicted (as that term is defined in 42 CFR 1001.2) of a felony offense that CMS determines is detrimental to the best interests of the Medicare program and its beneficiaries,” Waltz added.