The United States has filed a complaint under the False Claims Act against a resident of Florida and formerly the president, chief financial officer, and co-owner of a provider of mobile cardiac positron emission tomography (PET) scans. The US Attorney’s Office, Southern District of Texas, issued the press release on February 5, 2024.
The complaint alleges that the defendant knowingly participated in a scheme where the company paid doctors excessive fees beyond fair market value. These doctors referred patients to the company for cardiac PET scans, violating the Physician Self-Referral Law, commonly known as the Stark Law.
Cardiac PET scans are nuclear medicine tests that doctors use to help assess heart function and diagnose cardiac disease. The United States’ complaint alleges that the company provided cardiac PET scans on a mobile basis and paid the referring physicians, usually cardiologists, to provide the physician supervision required under Medicare rules. The United States alleges that from at least 2017 through June 2023, the defendant caused the company to enter into compensation arrangements with referring cardiologists, under which the cardiologists were paid as if they were fully occupied supervising the company’s scans, even though the cardiologists were actually providing care to other patients in their offices or were not even on site. The complaint alleges the company’s fees also purportedly compensated the cardiologists for additional services beyond supervision that were not actually provided.
The lawsuit was originally filed under the qui tam or whistleblower provisions of the False Claims Act (FCA) by a former billing manager at the company. The company and its current owner previously settled related claims arising from the conduct described above.
“Financial relationships between healthcare providers and referring physicians can undermine the objectivity of medical treatment decisions and increase the cost of care,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The Justice Department will enforce provisions designed to prevent prohibited financial conflicts to ensure that taxpayers and patients can have confidence that decisions about patient care are driven by the medical needs of patients rather than the financial interests of physicians or providers.”
Compliance Perspective
Issue
The Stark Law prohibits healthcare providers from billing Medicare for certain designated health services referred by a physician with whom the provider has a financial relationship, including a compensation arrangement, that does not meet any statutory or regulatory exception. Congress enacted the Stark Law to protect Medicare patients from financial arrangements that can adversely impact physicians’ decision making and lead to unnecessary services. Claims knowingly submitted to Medicare in violation of the Stark Law also violate the federal FCA. If a defendant is found liable for violating the FCA, the United States may recover three times the amount of its losses plus applicable penalties.
Discussion Points
- Review policies and procedures for preventing and reporting false claims and kickbacks. Also review your policies and procedures on determining if skilled rehabilitation services are reasonable and necessary. Update as needed.
- Train staff on federal and state anti-kickback statutes and what can be considered a kickback. Include information on how to report concerns and suspected violations, and make sure staff know that prompt reporting is mandatory. Provide education to nursing and business office personnel on their responsibility to identify and report any concerns that unnecessary medications, treatments, supplies, or equipment are being ordered for residents. Document that the trainings occurred and place in each employee’s education file.
- Periodically perform audits to ensure all staff are aware of their responsibility to identify and report compliance and ethics concerns and understand that it is their responsibility to report violations to their supervisor, the compliance officer, or via the anonymous hotline. Conduct audits of documentation and billing routinely to prevent and detect errors before they progress to a false claim.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
