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  • Writer's pictureSam Orlando

Feds: Sentara Healthcare and Optima Insurance Face Intensified Federal False Claims Investigation




Written by: Sam Orlando


HARRISONBURG, VIRGINIA – In what appears to be a tightening noose around Sentara Healthcare, the Department of Justice (DOJ) is rigorously enforcing multiple Civil Investigative Demands (CIDs) as part of an expanding probe into the healthcare giant's practices, according to documents filed in federal court on November 13, 2023. This latest surge in federal scrutiny comes on the heels of a previous incident where Sentara agreed to a substantial settlement over alleged violations of healthcare regulations.


Back on July 1, 2021, Sentara Healthcare found itself in hot water when it agreed to pay $4.3 million for allegedly violating the Civil Monetary Penalties Law by submitting improper claims for observation services. The settlement followed a self-disclosure by Sentara to the Office of Inspector General (OIG), where it was alleged that the healthcare provider submitted claims for observation services lacking necessary support for medical necessity, reasonableness, or correct billing units.


Fast forward to today, the DOJ is now enforcing CIDs, including numbers 21-337, 22-1024, 22-1026, and 23-1221, to extract vital documents and testimonies from Sentara’s top brass, including former CEO Howard Kern, according to the Court documents. These investigative actions are grounded in allegations that Sentara may have been involved in submitting false claims, leading to unjust government payments under the False Claims Act (FCA).


The heart of the current investigation revolves around Sentara’s rate filings for the ACA individual market plan years 2018 and 2019, according to the DOJ petition. The DOJ suspects that these filings may have led to the submission of false claims, resulting in substantial payments in Advanced Premium Tax Credits (APTCs). The government's probe seeks to determine whether decisions at the leadership level, particularly involving Kern, were instrumental in these filings, according to Court documents.


The enforcement of the CIDs by the DOJ signifies a serious escalation in the government's efforts to hold Sentara accountable.


This legal battle is not just about bureaucratic compliance but underscores a broader issue of accountability and transparency in the healthcare sector. The implications of this investigation are significant, impacting not just Sentara but potentially setting a precedent for the entire healthcare industry.


Breaking Through News reached out to Sentara Healthcare and Optima Insurance for comment on the Department of Justice allegations. As of press time Breaking Through News has not received any comment from the respondents.


As the case unfolds, Breaking Through News remains committed to providing insightful and up-to-date coverage of these developments. Stay tuned for more on this critical story as we continue to monitor the DOJ's actions against Sentara Healthcare.

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