Mobile Healthcare Service Provider to Pay $8.5 Million to Resolve False Claims Act Liability for Alleged Kickback Scheme
A vendor who provides mobile diagnostic services, including mobile x-rays, to residents in skilled nursing facilities (SNF) covered by Medicare and Medicaid has agreed to an $8.5 million settlement to resolve two False Claims Act cases filed by two whistleblowers on behalf of the U.S. government.
The government investigated the mobile service provider’s pricing arrangements and its costs to provide mobile x-rays at the SNFs based on the whistleblowers’ allegations that the vendor was engaged in a kickback scheme with the facilities.
Based upon its investigation, the government alleges that from approximately June 2006 through September 2019, the vendor engaged in illegal “swapping” arrangements through which it provided mobile x-rays to SNFs at prices below its costs for the services, or below fair market value. The intent of this arrangement was to induce the SNFs to refer lucrative federal health program business to the vendor.
Federal law prohibits the payment of kickbacks in exchange for the referral of federal healthcare business, including for healthcare that will be paid by the government through Medicare or Medicaid. The vendor, like other companies that submit claims for payment to Medicare or Medicaid, was required to certify that it was compliant with federal anti-kickback laws. The government alleges that the vendor’s certifications of anti-kickback law compliance were false certifications.
Compliance Perspective
Facilities that enter into illegal “swapping” agreements with vendors in exchange for services provided at below the vendor’s cost may be considered in violation of Federal anti-kickback laws and in jeopardy of losing their right to receive Medicare and Medicaid reimbursement.
Discussion Points:
- Review policies and procedures regarding vendor service providers and Federal anti-kickball laws that forbid accepting services provided at below the vendor’s cost in order to access the facility’s Medicare and Medicaid covered residents.
- Train staff involved in vendor contracts to be aware and to report any indications that a vendor is paying a kickback by charging below market value for services to obtain resident referrals from the facility.
- Periodically audit by comparing the costs being charged by vendors with the costs other vendors charge for the same services.
FRAUD MODULE 3: MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS
