Oak Street Health under Federal Investigation

The US Department of Justice (DOJ) is investigating Chicago-based Oak Street Health, a value-based primary care network for adults on Medicare, for possible violations of the False Claims Act according to the regulatory filing published on Nov.8.

The DOJ requested the healthcare facility to provide information related to the company’s free transportation for Medicare patients, as well as about its relationships with third-party marketing agents as the Federal Government is stepping up the crackdown on alleged fraud in the Medicare Advantage program.

How does Oak Street Health Operate?

The Oak Street inquiry is one of the many recent cases where the Federal Government is trying to establish whether the health provider violated the False Claims Act. The DOJ has been recording an increase in fraud and abuse as the Medicare Advantage plans have taken on a larger role in the Medicare program.

Since Oak Street has risk-based contracts with Medicare Advantage plans, its main revenue source comes from the Centers for Medicare & Medicaid Services (CMS) direct contracting program. In this way, the primary care company takes full responsibility for patients’ medical expenses while the Federal Agency provides the fixed per-patient monthly payment.

What Alleged Violations did Oak Street Health Commit?

According to the Oak Street Health representatives, the DOJ sent a civil investigative demand on Nov. 1 asking the company to provide information about their relationships with third-party marketers and transportation partners.

The civil investigative demand issued by the DOJ does not signify any form of legal action but is rather a request to provide documents or evidence that could be used by the Government to start an investigation into the potential False Claims violations. The actual investigation would determine whether there’s sufficient evidence to warrant filing an action.

Why is Whistleblowing Important for the Medicare System?

Government agencies encourage persons with non-public information regarding the Medicare and Medicaid system violations to help uncover fraud. At Khurana Law Firm, P.C., Medicare whistleblower lawyers, support the decision to share any relevant information and report abuse and fraud in the healthcare industry.

If you have become aware of a fraud or abuse scheme, you may be able to act as a whistleblower. The national whistleblower attorney Arvind Bob Khurana helps people to build a strong case that has helped whistleblowers receive a reward for aiding the government to fight fraud. Contact us today for a consultation. For a free, confidential evaluation call (888) 335-5107.