As we have discussed in the past, the federal Stark Law often intersects with the False Claims Act. In a recent case out of Florida, All Children’s Health System (ACHS) has agreed to remit $7 million to both the state and federal governments following allegations of Stark Law violations and False Claims Act misconduct. With healthcare fraud serving as the number one source of recovery under the False Claims Act, we encourage you to reach out to an experienced whistleblower attorney if you are aware of suspicious activity – particularly involving patients under Medicaid and Medicare healthcare policies.
Details of Case Against ACHS
The case against ACHS began when a courageous realtor, also known as a whistleblower, came forward by filing a lawsuit under the False Claims Act. The relator in this case was a former Director of Operations of Pediatric Physician Services, Inc., an organization working as a subsidiary of ACHS providing physician staffing for the medical system.
According to the relator’s complaint, a top-level executive employed by ACHS had engaged in unlawful negotiations and agreements with doctors pertaining to compensation agreements. These agreements allegedly far exceeded fair market value. In addition, the relator alleged that ACHS provided bonuses to doctors based on their productivity and patient interactions – a violation of both the Stark Law and False Claims Act.
The government ultimately declined to intervene in this case. However, the Department of Justice issued a Statement of Interest in the case hoping to resolve an apparently confusing area of the law. According to the Statement, the Stark Law prohibits unlawful referral arrangements as pertaining to both Medicaid and Medicare patients. Historically, Stark Law violations involved most Medicare patients and regulatory opinions on the matter were unclear.
Applicability of Stark Law to Unlawful Patient Referrals
The federal Stark Law is designed to help protect patients from tainted physician-patient relationships. More specifically, the law aims to eliminate a situation in which a doctor refers a patient for a medical service, procedure or appointment with a specialist pursuant to an underlying, undisclosed financial arrangement. The law recognizes that patients may not be offered appropriate medical advice when the involved parties are motivated by financial gain.
Medical facilities, doctors and hospitals found to be in violation of the Stark Law may also face False Claims Act liability if the patient involved is under a Medicare or Medicaid policy. Reason being, the government considers it to be a submission of a false claim when a medical professional seeks reimbursement for services rendered pursuant to an agreement for financial compensation.
Contact an Experienced Whistleblower Attorney Today
The whistleblower laws under the False Claims Act and Stark Law are highly nuanced and require the assistance of an attorney with experience in qui tam litigation. However, a successful whistleblower can expect to receive up to 30 percent of the ultimate recovery. For more information about filing your own whistleblower lawsuit, or if you are aware of potentially suspicious activity involving Medicare or Medicaid patients, please contact us today.