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Anti-Kickback and Stark

This archive displays posts tagged as relevant to the Anti-Kickback Statute and Stark Law.

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February 28, 2024

The owner and operator of a clinical laboratory in Georgia has pleaded guilty and agreed to pay $14.3 million to resolve charges of paying illegal kickbacks and causing false claims to be submitted to Georgia’s Medicaid program.  According to Capstone Diagnostics’ former laboratory manager, Andrew Maloney directed Capstone to pay volume-based commissions to independent sales representatives in exchange for them arranging medically unnecessary urine drug tests and respiratory pathogen panels to come their way.  The laboratory ultimately submitted over $1 million in tainted claims to Georgia Medicaid.  For bringing a successful case under the False Claims Act, whistleblower Jesse Allen will receive almost $3 million.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicaid, Whistleblower Case, Whistleblower Rewards,

Top Ten Healthcare False Claims Act Recoveries for 2023

Posted  01/30/24
Doctor Holding Stethoscope with Crossed Arms
This past year was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool.  And as we noted in our recent Top Ten listing of False Claims Act recoveries for 2023, all but 3 of the Top Ten recoveries were in the healthcare space involving various schemes to defraud Medicare and Medicaid.  So here is our look at the Top Ten healthcare recoveries for...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

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Testing Lab and Owner/CEO Settle False Claims Act Case for $13.25 Million

Posted  01/12/24
Laboratory Analysis. Scientist Measuring Sample
RDx Bioscience Inc. (“RDx”), a clinical laboratory that operated in New Jersey, and its owner and CEO agreed to pay $13.25 million to settle a False Claims Act case alleging kickbacks and unnecessary testing schemes, according to a recent DOJ press release.  The press release also notes that RDx and its owner/CEO agreed to cooperate with the DOJ’s “investigations of, and litigation against, other participants...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity,

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Top Ten False Claims Act Recoveries in 2023

Posted  01/11/24
It was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. As usual, most of the recoveries were in the healthcare space with seven of the Top-10 involving various schemes to defraud Medicare and Medicaid. Several of these Top-10 recoveries involved enforcement actions targeting violations of the Anti-Kickback Statute and Stark Law, which prohibit medical...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Government Programs Fraud, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

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January 10, 2024

Clinical laboratory RDx Bioscience Inc. and its owner and CEO Eric Leykin have agreed to pay over $10 million to the federal government and about $3 million to the State of New Jersey for violating the Anti-Kickback Statute and federal and state False Claims Acts.  From 2018 to 2022, RDx and Leykin were allegedly involved with five types of kickback schemes in order to induce referrals to RDx for laboratory testing, then submitted or caused false claims to be submitted to Medicare and Medicaid that were unnecessary or uncovered.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medicare,

January 4, 2024

ChristianaCare has paid $42.5 million for violations of the federal False Claims Act and the Delaware False Claims and Reporting Act. In a qui tam whistleblower complaint filed in 2017, ChristianaCare's former chief compliance officer alleged illegal remuneration was provided to non-employee neonatologists and surgeons in the form of free or below fair market services by ancillary support providers, such as nurse practitioners, hospitalists, and physician assistants. These services were meant to induce referrals from the non-employees, creating a financial relationship. USAO DE

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Provider Fraud, Whistleblower Case,

December 22, 2023

Christiana Care Health System has agreed to pay over $7.6 million to the State of Delaware for violating the federal and state False Claims Acts, and Delaware’s Patient Brokering and Anti-Kickback laws.  According to a qui tam whistleblower, who filed a case in 2017, the healthcare system provided free or below-market rate support services to doctors in exchange for referrals of Medicaid patients, then submitted false claims stemming from those referrals to Delaware’s Medicaid program.  DE AG

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Provider Fraud, Whistleblower Case,

Community Health Network Pays $345 Million to Settle Stark Law Case

Posted  12/21/23
Handshake in room with dark window blinds
Community Health Network Inc., based in Indianapolis, recently settled with the U.S. government for $345 million, addressing allegations under the False Claims Act related to the Stark Law. This landmark case emphasizes the importance of whistleblowers to combat Medicare fraud. The Stark Law prevents hospitals from billing Medicare for services referred by physicians who have a financial relationship with the...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Whistleblower Case,

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December 21, 2023

Ultragenyx Pharmaceutical, Inc., maker of Crysvita, will pay $6 million for violating the False Claims Act. Crysvita is prescribed to treat a rare inherited blood disorder, which may require a genetic test to definitively diagnose. To induce purchases and referrals, Ultragenyx paid a laboratory to conduct genetic tests at no cost to healthcare providers or patients, and then provide the results reports to Ultragenyx. Ultragenyx then used the positive test results reports to target healthcare providers for Crysvita sales. Internally, Ultragenyx referred to this kickback scheme as their "sponsored" testing program. The program was exposed via a qui tam whistleblower, who will receive $1.07 million of the $6.7 million recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medicare, Pharma Fraud, Whistleblower Case,

December 19, 2023

Indiana-based Community Health Network Inc. has agreed to pay $345 million to resolve claims by its former CFO and COO Thomas Fischer, which alleged the healthcare system submitted claims to Medicare that were tainted by violations of the Stark Law.  In order to capture physicians’ downstream referrals, Community paid physicians salaries that were sometimes double market rate, and awarded them bonuses based on the number of referrals.  Community then submitted claims resulting from these referrals for reimbursement.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, Whistleblower Case,

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