The Department of Justice (DOJ) recently announced a settlement between the government and a family of integrated hospitals and health care providers that operate in New York. The settlement includes an agreement to pay the State of New York $895,427 and an additional $14 million to resolve allegations of violation of the False Claims Act.
The DOJ accused the group of filing improper claims for health-related services. Examples include:
- Inadequate records. The government accused the hospital system of failing to keep adequate records to support the level of service billed.
- Physician Self-Referral violation. The government also accused the group of an improper financial relationship with two orthopedic physicians. The physicians received compensation from the hospital group, but the government alleges the compensation provided for services exceeded fair market value. The agency used this evidence to support allegations of violation of the Physician Self-Referral Law.
- Anti-Kickback Statute violation. The relationship noted above was also allegedly in violation of the federal Anti-Kickback Statute.
The settlement is another example of the government’s continued efforts to crackdown on Anti-Kickback and False Claims Act violations. The Acting Assistant Attorney General for the Justice Department’s Civil Division stated that the resolution serves a “testament to [the government’s] deep commitment to protecting the integrity of federally-funded healthcare programs.”
Hospital groups like the one noted above are not the only health care providers at risk. The government can also investigate individual medical professionals for these violations. Those that face such accusations are wise to promptly seek legal counsel to better ensure their professional and personal reputations are protected.