Healthcare Compliance Perspective:
The Anti-Kickback Statute makes it a crime to knowingly and willfully offer, solicit, or receive any remunerations for referrals of services reimbursable by a federal health care program. Violating the Anti-Kickback Statute may result in false claims or civil monetary penalties.
Multiple mobile imaging companies, along with their owners will pay the United States $300,000 after improperly billing Medicare for transportation charges related to portable x-ray services. One of the companies also entered into a deferred prosecution agreement with the United States to resolve swapping allegations, which implicated the Anti-Kickback Statute.
In March 2011, two relators filed a lawsuit under the qui tam provisions of the False Claims Act. The relators alleged that the defendants improperly billed for portable x-ray services and unlawfully paid kickbacks to skilled nursing facilities (SNFs) in exchange for patient referrals-something the relators referred to as “swapping.” Relators will receive a 19% share of the United States’ recovery.
The United States intervened in the action for purposes of settlement. The defendants agreed to pay the United States $300,000 to resolve allegations they submitted improper claims to the Medicare program for transportation charges, and agreed to a judgment in favor of the United States.
The United States began a criminal investigation regarding allegations of improper remunerations by one of the imaging providers in exchange for referrals from some SNFs. The criminal investigation revealed that for about four years, the imaging provider offered and paid illegal remunerations, of free and significantly discounted portable x-ray services, to administrators of SNFs in exchange for the referral of the SNF’s Medicare beneficiaries to the imaging provider for portable x-ray services. The free and significantly discounted portable x-ray services were covered by the SNF’s Part A per diem payment and provided to the SNFs in exchange for the SNF referring to the imaging provider other Federal health care program business, namely Part B business excluded from consolidated billing-something that the imaging provider could bill directly to Medicare.
The imaging provider entered into a deferred prosecution agreement with the United where the imaging service acknowledged that the arrangements entered into between itself and the SNFs violated the Anti-Kickback Statute and amounted to unlawful “swapping” arrangements. The imaging service agreed to cooperate with the government in the investigation and prosecution of the SNFs and individuals involved in the illegal swapping arrangements and to comply with all applicable federal health care laws.
