The federal government takes health care fraud very seriously. In 1996, the passage of the Health Insurance Portability and Accountability Act (HIPAA) resulted in the development of a national program focused on the investigation and prosecution of those who commit health care fraud crimes. The program, now in effect for over twenty years, has resulted in billions of dollars of awards.
As noted in a recent report by Becker’s Hospital Review, some of the biggest Anti-Kickback violation settlements brought in by this program occurred this past year. Some examples include:
- Health Quest Systems. The New York based health system and its subsidiaries agreed to pay almost $15 million to the federal government along with an additional $895,427 directly to New York. The settlement included allegations the group partook in an arrangement with two physicians that violated the Stark Law because the arrangement exceeded fair market value. This arrangement, according to the government, was intentionally above fair market value to entice the physicians to refer patients to Health Quest Systems’ facilities.
- Community Health Systems. The hospital group from Tennessee agreed to pay the government over $262 million to settle claims the hospital used illegal kickbacks to grow business.
- UPMC Hamot. The hospital, along with a private practice cardiology group, faced allegations initiated with a whistleblower case. The case resulted in an agreement to pay the government an estimated $20.7 million to settle the claims. The settlement was based on allegations the group submitted claims to Medicare and Medicaid from 1999 to 2010 that were in violation of the Anti-Kickback Statute.
These were just some of the more notable cases from 2018. Like 2017, the government likely gained billions in health care fraud judgments and settlements during 2018.
Although those who defraud Medicaid should be held accountable, it is important to note that not all who are accused are guilty. False accusations can occur. Those who are falsely accused are wise to build a defense against the accusations. An attorney experienced in this niche area of the law can help.