The United States Department of Justice (DOJ) continues its crackdown on illegal kickbacks within the healthcare industry. In a recent example, the feds went after lab service providers in Texas for allegedly making illegal payments to physicians and falsely claiming the funds were in exchange for advisory services.
What were the details of the charges?
The 26-count indictment lists ten people and various healthcare fraud charges including violations of the Antikickback Statute (AKS). The accused include the owners and founders of several lab companies, an internal medicine specialist, a family medicine practitioner, and a nurse practitioner as well as the owner and multiple workers within a local marketing firm. The government claims the lab provided the medical professionals with payment based on the number of tests ordered from the lab thus incentivizing them to order tests and services that were medically unnecessary.
The lab countered that it paid these funds in exchange for advisory services, but no record of such services exists.
The DOJ states these claims led to over $300 million in false claims.
How serious are the charges?
If the government can build a successful case, the accused face over 55 years of imprisonment.
What kind of evidence does the government need to build a case for these types of allegations?
In this example, the government claims to have evidence of an agreement stating the lab would pay a portion of the physicians’ salaries and office lease contingent on the number of lab tests. They also claim to have evidence to establish the lab made direct payments to the partners of the accused.
What can Texas lab owners learn from this case?
Keep proper records. If payment is made in exchange for advisory services, make sure the arrangement is in compliance with federal laws and keep proper documentation in the event of similar allegations of wrongdoing.
Lab owners can further safeguard their business by conducting regular internal audits. This can provide an opportunity to make adjustments to better ensure compliance.
Attorney John Rivas is responsible for this communication