Medicare and Medicaid have paid out millions of dollars to whistleblowers who have helped uncover violations of the Stark Law, which is also known as the physician self-referral statute.
The Stark law prohibits physicians from referring Medicare or Medicaid patients to other healthcare providers or entities with which the physician or an immediate family member has a financial relationship. A financial relationship includes an ownership interest, a passive investment interest, and compensation arrangements. For example, the Stark Law prohibits a physician from referring patients to an imaging center the physician has invested in, unless an exception applies. The prohibition applies to a long list of "designated health services," including:
The Stark law is a strict liability statute. This means that the government does not have to prove that the physician intended to violate the statute. If the referral violated the Stark Law, then any claims submitted to Medicare or Medicaid are automatically considered “false claims.” The penalties for Stark Law violations are severe. The physician and the entity that received the referrals may be required to pay back up to three times the amount Medicare or Medicaid paid for the services, plus fines of up to $11,000 for each claim. In addition, those involved may be excluded from Medicare and Medicaid programs, and they may face suspension or loss of their professional licenses. Stark Law violations are often difficult for the government to discover. That is why the government relies on whistleblowers to come forward with evidence. In return, the government pays whistleblower rewards of between 15% and 30% of the amount the government recovers. The rewards often amounts to hundreds of thousands of dollars, and sometimes millions of dollars. If you have evidence that a physician or physician practice group is engaged in self-referrals that violate the Stark Law, then you should consult with a whistleblower attorney immediately. You must comply with strict time limits and procedural requirements in order to qualify for a whistleblower reward. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Two compounding pharmacies and four physicians have agreed to pay $10 million to settle allegations of false claims submitted to TRICARE, the military’s healthcare program.
The government alleged that one of the compounding pharmacies, Topical Specialists, was created by the four physicians and a pharmacist. The physicians referred their military patients to Tropical Specialists, but it was unable to obtain contracts with government healthcare programs. Topical Specialists then sent its prescriptions to another pharmacy, WELLHealth, which submitted the prescriptions to the federal government. The government alleged that the physicians steered military patients to Tropical Specialists with hundreds of costly prescriptions for pain and scar creams that may not have been medically necessary. Many of the patients told the government that they never used the creams. While the pharmacies billed the federal government tens of thousands of dollars for the creams, the actual cost of compounding the creams was only 4-5% of the amount billed to TRICARE. The government alleged that profits of up to 90% were passed on to the four doctors behind Tropical Specialists. The government also alleged that the four doctors recruited other doctors to write prescriptions to be filled by Tropical or WELLHealth, and passed along 40% of the reimbursement to those doctors. The doctors and the pharmacies settled the government’s fraud claims by agreeing to pay $10 million. False claims to government healthcare programs are very difficult to detect. For this reason, the government offers substantial rewards to whistleblowers who come forward with evidence of false claims to Medicare, Medicaid, and TRICARE. The whistleblower rewards range from 15% to 30% of the amount to government actually recovers plus attorneys’ fees and costs. Anyone who has evidence of false claims can become a whistleblower. This includes physicians, medical and billing staff, patients, vendors and competitors. If you have evidence of false claims submitted to Medicare, Medicaid or TRICARE, then you should consult with an experienced whistleblower attorney immediately to protect your rights. You may be entitled to a significant reward and legal protections. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Whistleblower cases are taken on a contingency fee basis, which means there are no legal fees unless you win. Whistleblowers Alleged Millennium Laboratories Submitted False Claims to Medicare and Medicaid for Unnecessary Drug and Genetic Testing
A group of whistleblowers will share more than $31 million in rewards as part of a settlement of claims that Millennium Laboratories billed Medicare, Medicaid and other government healthcare programs for unnecessary urine and genetic testing. The whistleblowers also alleged that the laboratory company gave free supplies to physicians in return for patient referrals. The whistleblowers alleged that the lab company promoted so-called “custom profiles,” which effectively created standing orders from physicians for large numbers of lab tests without an individualized assessment of each patient’s needs. These standing orders allegedly resulted in Medicare and Medicaid paying for urine and genetic tests that were not medically necessary for the diagnosis and treatment of an individual patient’s illness or injury. The whistleblowers also alleged that the lab company provided physicians with free urine drug test cups, but only if the physicians agreed to return the urine specimens to the lab company for lab testing. The Stark Law and the Anti-Kickback Statute generally prohibit laboratories from giving physicians anything of value in exchange for patient referrals. The lab company agreed to settle these allegations by paying $256 million. Of that amount, the whistleblowers will receive more than $31 million in rewards. The lawsuits were filed by current and former employees, competitors, and private insurance companies under the qui tam or whistleblower provisions of the False Claims Act. A qui tam lawsuit is filed by a private individual or entity on behalf of the government to recover money paid by the government for false claims. The qui tam suit is initially filed “under seal” (i.e., in secret), and the whistleblower’s evidence is provided to the government. After conducting an investigation, the government decides whether to pursue the case. If the government recovers money as a result of the qui tam lawsuit, the whistleblower is entitled to a reward of between 15% and 30% of the amount the government actually recovers. If you have evidence that a lab company or healthcare provider has submitted false claims to Medicare or Medicaid, then you should consult with an experienced healthcare fraud whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. An orthopedic surgeon has been awarded an $18.1 million whistleblower reward for helping the government uncover and stop a hospital’s program of paying above-market compensation to physicians in return for patient referrals.
Dr. Michael K. Drakeford, an orthopedic surgeon, was offered a contract with a hospital that would have paid him above-market compensation in return for referring his patients to the hospital. Recognizing that the contract might violate the Stark Law, the physician sought legal advice. The Stark Law prohibits hospitals from billing Medicare or Medicaid for services that have been referred by physicians with whom the hospital has an improper financial relationship. There are many exemptions or “safe harbors” in the Stark Law to allow for legitimate compensation relationships. But the hospital may not pay more than the fair market value for the physician’s actual services, and it may not condition the payments on the volume or value of the physician’s referrals of patients to the hospital. Instead of entering into what he believed to be an illegal contract, Dr. Drakeford started a whistleblower lawsuit under the False Claims Act. That statute allows an individual to commence a lawsuit on behalf of the government to recover for false claims to Medicare, Medicaid, and other government programs. The lawsuit was filed “under seal” (i.e., in secret), and the physician’s evidence was provided to the government. After conducting an investigation, the government decided to take over the lawsuit. At trial, the jury found that the hospital had submitted more than 21,000 false claims to Medicare. Under the False Claims Act, a whistleblower is entitled to a reward of between 15% and 30% of the amount actually recovered by the government. In this case, the whistleblower will receive an $18.1 million reward. If you have evidence that a hospital is paying above-market compensation to doctors in return for patient referrals, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be eligible for a substantial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. |