On March 12, 2024, a New York hospital settled allegations of unlawful kickbacks to physicians at its chemotherapy infusion center. These kickbacks were tied to the number of referrals physicians made for services at the center. A Department of Justice investigation found that physicians at the chemotherapy infusion center were paid based on referral volume.
The hospital agreed to pay $17.3 million to resolve claims under the federal and New York State False Claims Acts. Of the total settlement amount, $16.410 million is to be paid to the federal government, and $890,000 is to be paid to New York State.
The settlement agreement also resolves claims that physicians at the infusion center failed to adequately supervise the chemotherapy services. Billing for medical services must involve those who participated in patient care. While non-physicians, like nurses, can provide care, supervision by an available physician is often necessary.
The hospital voluntarily self-disclosed the issues to the United States.
Compliance Perspective
Issue
Medicare and Medicaid rules prohibit physicians from receiving any kind of remuneration in exchange for patient referrals for services. Medicare and Medicaid rules also require that those billing for medical services be involved in providing the services. Otherwise, the claims can be deemed to be violations of the False Claims Act. The Federal Anti-Kickback Statute is a law that prohibits any business or a person from offering money to any medical personnel in return for the recommendation of product or services to patients on certain federally covered medical programs. These medical programs include Medicare and Medicaid. If a financial offer includes payment in exchange for referrals, the Anti-Kickback Statute has been violated and everybody involved can be prosecuted. This can include doctors, nurses, medical suppliers, pharmacists, or anyone else that may have benefited from the kickback. Violators will be prosecuted in federal court and can face significant fines and prison time. Healthcare providers, suppliers, or other individuals or entities subject to Civil Monetary Penalties can use the Office of Inspector General’s (OIG) Self-Disclosure Protocol to voluntarily disclose self-discovered evidence of potential fraud.
Discussion Points
- Review policies and procedures for preventing and reporting a false claim or anti-kickback statute violation. Update your policies and procedures as needed.
- Train all staff on the False Claims Act and Anti-Kickback Statute and what can be considered a false claim or kickback. Include information on how to report concerns and suspected violations, and that prompt reporting is mandatory. Document that the training occurred and place in each employee’s education file.
- Periodically audit staff understanding to ensure that they are aware of what should be done if they suspect a false claim or illegal kickback has occurred, whether intentionally or unintentionally. 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.*
