The government expects healthcare providers to focus on patient care over financial gain. There are many regulations in place to help better ensure patients are protected and reduce the risk of temptation for healthcare professionals, but there are still those who abuse the system.
The government takes any allegations of abuse very seriously. Unfortunately, this can lead to false allegations of wrongdoing. Due to this aggressive approach, it is important that any physician or healthcare group under investigation for a violation of one of these regulations take the matter seriously.
How does the government build these types of cases?
The government often relies on tips and complaints of potential fraud and abuse. Anyone can report information to the government through the Department of Health and Human Services.
In a recent example, the government pursued an investigation of Essilor, an optical company out of Dallas based off such a tip. The group distributes, manufactures, and markets optical lenses and equipment. The Department of Justice (DOJ) got a tip that a neurosurgeon was engaged to the owner of the group and used the group to purchase medical products.
As a result of the investigation, the government claims to have gathered enough evidence to support the claim that the group offered or paid remuneration to optometrists and ophthalmologists in exchange for agreements to purchase their products — a violation of the Anti Kickback Statute (AKS). When presented with the evidence, the group chose to accept a settlement. The group settled the claim for over $16 million.
What are the penalties for AKS violation?
They can vary depending on the details. In this case, the penalties included:
- Corporate Integrity Agreement. It is not uncommon for the government to expect the accused to enter a Corporate Integrity Agreement (CIA) as part of a settlement agreement. The CIA generally includes an internal audit by an independent organization to better ensure compliance with the AKS and may include additional government oversight.
- Financial penalty. The settlement includes an agreement to pay the government $16.4 million.
Those who provided the tip will get a portion of the settlement funds.
Attorney John Rivas is responsible for this communication.