The Department of Justice is ramping up enforcement efforts focused on questionable financial arrangements among providers, according to former U.S. Department of Health and Human Services Inspector General Richard P. Kusserow, as an influx of kickback cases make headlines nationwide. Lawsuits filed under the Stark Law and Anti-Kickback Statute are rising to the level of False Claims Act cases, as FierceHealthPayer: Anti-Fraud reported.
In Texas, for example, 10 people were charged in an alleged kickback scheme involving Medicare and Medicaid, the Houston Chronicle reported. The 13-count indictment alleges that executives of Continuum Healthcare LLC billed for mental health services that were unnecessary or not provided. They also reportedly approved kickbacks to personal home care company owners and patient advocates in return for client referrals to three clinics.
Continuum collected $69.4 million for the scheme, the Chronicle noted. Those charged face a maximum sentence of five years in prison and a $250,000 fine, and three people face additional charges of laundering more than $10,000 in kickback proceeds.
Meanwhile, in New Jersey, Somerset Medical Center agreed to pay $435,640 to settle allegations that it made improper rental payments to cardiologists in exchange for referrals, the DOJ announced. In a lawsuit brought by two former employees turned whistleblowers, the government alleged the medical center paid rental fees exceeding fair market value and billed Medicare for services following improper payments.
Elsewhere in New Jersey, a radiologist who ran a diagnostic testing center was sentenced to nearly four years in prison for overseeing a kickback scheme, according to the Associated Press. Prosecutors say Ashokkumar Babaria must forfeit more than $2 million in "corrupt revenues" received from Medicare and Medicaid for testing patients referred by providers who pocketed kickbacks for referrals.
And in Chicago, a three-year federal investigation recently came to light when four doctors and two Sacred Heart Hospital executives were arrested in connection with a scheme that reportedly reaped more than $225,000 in cash and at least $2 million in healthcare payments, according to The Chicago Tribune.
Authorities say the scheme exposed the poor and elderly to dangerous procedures they didn't need--including unnecessary and prolonged sedation, tracheotomies and penile implants--all of which the providers billed to government programs. The investigation also exposed a system to admit nursing home patients to Sacred Heart "irrespective of any medical necessity" by using ambulance companies that transported them as emergency room patients and billed Medicare, The Tribune noted.
For more:
- read Kusserow's commentary
- here's the Houston Chronicle article
- see the AP article
- read the DOJ announcement
- here's The Chicago Tribune article