July 8, 2021. When going to the doctor, one generally trusts a medical professional to refer a patient to the most medically appropriate provider, not to a provider or facility who will enrich the referring doctor.
The United States Department of Justice settled a case against Akron General Health System (AGHS) for $21.25 million. Allegations include:
Anti-Kickback Statute & Physician Self-Referral Law (Stark Law) Violations:
The hospital system paid “compensation substantially in excess of fair market value” for patient referrals to area physician groups.
False Claims Act Violations:
After referring patients to these physician groups, the hospital system submitted claims to Medicare, Medicaid, and other federally funded programs for “services provided to these illegally referred patients,” thus defrauding the government.
The Cleveland Clinic Foundation acquired the health system in 2015 and discovered these improper financial arrangements. A former internal auditor of the health system reported the fraud and is entitled to receive 15-25% of the government’s recovery.
Physicians’ self-serving referrals are deleterious to the public’s trust in their profession, harmful to wrongly referred patients, and erodes the foundation of taxpayer-funded medical programs, which are intended to support vulnerable populations.
If you would like to report health care fraud, you can contact attorneys at Tycko & Zavareei LLP. Eva Gunasekera and Renée Brooker are former officials of the United States Department of Justice and prosecuted whistleblower cases under the False Claims Act. Eva was the Senior Counsel for Health Care Fraud. Renée served as Assistant Director at the United States Department of Justice, the office that supervises False Claims Act cases in all 94 United States District Courts. Eva and Renee now represent whistleblowers. For a free consultation, you can contact Renée [email protected] or 202-417-3664. Or contact Eva Gunasekera at [email protected]. You can also go to Tycko & Zavareei LLP’s website for whistleblowers to learn more at https://www.fraudfighters.net/.