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Texas physicians group agrees to health care fraud settlement

Texas-based EmCare doctors “provide emergency medicine, hospital medicine, general and trauma surgery, anesthesiology and radiology/teleradiology care to hundreds of hospitals and healthcare facilities throughout the country,” the company says on its website. It is perhaps unsurprising that the Dallas firm makes no mention of its recent agreement with the U.S. Department of Justice to settle claims that it engaged in health care fraud.

EmCare agreed to pay more than $29 million to settle claims that it accepted kickbacks for four years in exchange for recommending inpatient admissions to hospitals that were owned by Health Management Associates (HMA). The DOJ alleged that EmCare improperly referred patients for inpatient admission who were suited to outpatient care.

Community Health Systems bought the hospital chain in 2013.

The DOJ said HMA reaped enormous financial dividends from the referrals because Medicare reimburses providers about three times more for inpatient care versus outpatient treatment.

HMA was also accused of paying bonuses from 2008 through 2012 to EmCare doctors and clinicians who referred emergency room patients for inpatient care.

In a separate agreement, a Pennsylvania physicians group is resolving similar kickback claims for $4 million. Doctors in that organization allegedly received kickbacks from HMA for patient referrals to two Lancaster-area hospitals.

Two whistleblowers in the EmCare settlement are to split $6,222,907, the DOJ said in a press release.

If you are under investigation for alleged violations of the Stark Law or Anti-Kickback Statute, speak to a health care law attorney before talking to investigators or law enforcement.