Coronary Heart Diagnostics Laboratory Settles Federal Allegations of Kickbacks to Physicians for $26.7 Million
A coronary heart diagnostics laboratory has agreed to pay $26.67 million in order to resolve False Claims Act allegations involving payments for patient referrals in violation of the Anti-Kickback Statute, and the Stark Law. Also involved are claims improperly billed to federal healthcare programs for laboratory testing.
The company, operating throughout the United States, is described on its website as a provider of diagnostic and patient management solutions and coronary heart disease risk assessment tests, lipid testing, and measurement of cholesterol
The settlement resolves allegations that the laboratory provided physician practices with in-office dieticians in exchange for physician referrals for laboratory testing. These allegations were originally made in a case filed in the Eastern District of California under the whistleblower, or qui tam, provision of the False Claims Act. The settlement also resolves allegations that the laboratory directly or indirectly paid processing and handling fees and waived patient copayments and deductibles. These allegations were originally made in the District of Columbia under the Act.
Additionally, the settlement resolves allegations that the laboratory conspired with others to pay doctors kickbacks disguised as investment returns and conspired with certain Texas hospitals and others to submit claims for outpatient laboratory testing for patients who were not hospital outpatients, in order to receive higher reimbursements from federal health care programs.
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally funded programs. The Stark Law forbids a laboratory from billing Medicare and Medicaid for certain services referred by physicians that have a financial relationship with the laboratory. The Anti-Kickback Statute and the Stark Law are intended to ensure that medical providers’ judgments are not compromised by improper financial incentives, and are instead based on the best interests of their patients.
Compliance Perspective
Failure to ensure that the facility is not contracting with vendors who have violated the Anti-Kickback Statute and the Stark Law by paying for patient referrals and submitting improperly billed claims to Medicare and Medicaid programs, may jeopardize the facility’s eligibility to participate in the reimbursement of claims by Medicare and Medicaid.
Discussion Points:
- Review the policies and procedures for verifying and contracting with service providers to ensure they have not violated state and federal regulations and are not excluded as providers by Medicare and Medicaid.
- Train staff involved in contracting and screening verification processes about the requirements for participation.
- Periodically audit to determine if any of the vendors providing services to the facility have been excluded by Medicare and Medicaid for any reason.
FRAUD MODULE 3: MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS
