The United States Department of Justice (DOJ) recently announced charges against a dermatopathologist out of Texas. The DOJ states the fraud began in 2015, when the physician authorized a management company to use the lab’s license to submit claims for payment for various lab tests. The government claims that the management company would then pay 20% of the funds received from paid claims back to the physician’s clinic.
Ultimately, the DOJ is attempting to hold the physician accountable for his role in allegedly defrauding the government of over $4 million.
An attempt to avoid AKS violations
The Anti-Kickback Statute (AKS) is a federal law that applies when there are fraudulent claims made to federal programs, like Medicare. The prosecution claims to have evidence that the physician in this case attempted to avoid stepping afoul of the AKS by not submitting claims to federal programs.
The management company did not follow these rules and began submitting claims to federal healthcare programs. The agency states that the physician continued to allow the management company to use his clinic’s license even after the physician became aware of this violation.
A misguided plan
It is also important to note that this could have still led to charges. As noted in previous posts, the federal government has found success prosecuting violations under the Travel Act — essentially moving forward with similar charges when the accused has only committed fraud against private programs.
An attempt to recoup funds
The government’s goal is to recoup the lost funds. However, the physician, clinic and management company could also face additional civil penalties.