The Department of Justice (DoJ) has announced a $750,000 settlement in a Medicare kickback case.
This settlement resolves allegations brought by a Maryland whistleblower under the False Claims Act (FCA). The FCA allows whistleblowers who uncover fraud against the government to file an action on behalf of the government and share in any recovery. The whistleblower in this case will receive $121,500 for bringing the alleged fraud to light.
According to the DoJ’s press release, “the defendants allegedly induced patient referrals by providing ankle-brachial index testing on patients under agreements with the referring physicians but without collecting from the physicians the fair market value for the tests.”
It is a violation of federal law to offer, pay, or receive kickbacks for referrals of Medicare patients. 42 U.S.C. § 1320a-7b(b). This is known as the Anti-Kickback Act. It applies to various forms of government healthcare, including Medicare, Medicaid, and Tricare. Kickbacks can include a wide array of remuneration beyond simple cash exchanged for referrals. Compliance with this law is an express condition of payment under government health programs. Providers who falsely certify compliance with these rules may be held civilly liable to whistleblowers and the government under the FCA.
The settlement discussed above is based on allegations only. There has been no determination of guilt or liability.