A West Virginia whistleblower who uncovered a Medicare kickback scheme will receive a reward of $10 million out of the government’s total $50 million recovery.  The Department of Justice announced that a West Virginia Hospital allegedly violated the Stark Law and Anti-Kickback Statute (AKS) by “paying improper compensation to referring physicians.”

AKS prohibits physicians for offering, paying, or receiving kickbacks for referrals of Medicare and Medicaid patients.  42 U.S.C. § 1320a-7b(b).  The Stark Law, similarly prohibits physicians from referring a patient to a facility if the referring physician has a financial relationship with that facility.  42 U.S.C. § 1395nn (a)(1), (h)(6).

Compliance with these laws is an express condition of payment under Medicare and Medicaid programs.  Providers who falsely certify their compliance with these rules may be held civilly liable to whistleblowers and the government under the False Claims Act (FCA).  The FCA allows individuals who uncover fraud against the government to become whistleblowers and share in any potential recovery.

If you have uncovered fraud against the government, contact the whistleblower attorneys at Miller Law Group today for a free and confidential consultation.  You can also set up a consultation by calling us at (919) 348-4361.

The settlement discussed above is based on allegations only.  No determination of liability has been made.

Additional Resources:

STARK: When can physicians refer patients to their group practice?

Medicare Fraud Whistleblower – Paying Patient Co-pays

Telemedicine Fraud: Safely Distanced or a Smoke Screen?