DECEMBER 21, 2023. The Principal Deputy Assistant Attorney delivered remarks announcing the largest False Claims Act settlement based on Stark Law violations in history. Community Health Network (Community), a non-profit health network located in Indianapolis, Indiana, has agreed to pay $345 million to resolve claims that it submitted false claims to Medicare as part of a kickback scheme.
The Principal Deputy Assistant Attorney detailed the importance of the Stark Law:
“An important focus of our health care fraud enforcement efforts has been to ensure compliance with the Physician Self‑Referral Law, commonly known as the Stark Law. The Stark Law prohibits a hospital from billing Medicare for certain services referred by a physician who has a financial relationship with the hospital, unless that relationship satisfies one of the law’s statutory or regulatory exceptions. The Law is intended to ensure that medical decision-making by physicians is not compromised by improper financial incentives and is instead based on the best interests of the patient.”
The government alleged that starting in 2008, Community aggressively recruited physicians by paying them rates that were well above market value, giving them an incentive to refer Community to their patients, thus undermining their judgment when caring for patients. Community then billed Medicare for these services that were referred by physicians with whom they had improper financial relationships. Because of this, these claims were tainted and ineligible for payment, which Community knew. The government further stated that because of these false claim submissions, Community received millions of dollars in reimbursements from Medicare that it should have never received, in violation of the False Claims Act.
The Principal Deputy Assistant Attorney stated that the Justice Department is “focused on ensuring that physicians provide objective medical advice to their patients – advice that is not tainted by improper financial relationships [and] will continue to use the False Claims Act to protect the integrity of federal health care programs and to prevent the waste and abuse of taxpayer funds.”
If you would like to report healthcare fraud including violations of the Anti-Kickback Statute and Stark Law, 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 was the Senior Counsel for Health Care Fraud. Eva and Renée now represent whistleblowers. For a free consultation, you can contact Renée at [email protected] (tel.: 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 www.fraudfighters.net.