Florida Hospital District Agrees to Pay the U.S. Government $69.5 Million for Alleged Medicaid and Medicare Health Care Fraud; Whistleblower Will Receive Over $12 Million
On September 15, 2015, the Department of Justice (DOJ) announced that Broward Health, an operator of more than 50 health care facilities across Broward County in Florida, agreed to pay the U.S. government $69.5 million for violating the Federal Stark Law and the Anti-Kickback Statue by allegedly compensating its referring physicians for services that exceeded the fair market value – a practice allegedly used to cover up illegal kickbacks paid to physicians in exchange for patient referrals. Dr. Michael Rielly, a former employee of Broward Health and the whistleblower in this case, will receive over $12 million for exposing Broward Health’s illegal practices by bringing a qui tam case under the False Claims Act (FCA).
Under the Federal Stark Law and the Anti-Kickback Statue, it is illegal for health care providers and physicians to knowingly accept bribes or other forms of compensation in return for making referrals that result in claims on federal healthcare programs, such as Medicare and Medicaid. These laws are designed to protect patients and the federal health care programs from fraud and abuse. The laws specifically apply to any physician who provides care to Medicare or Medicaid beneficiaries, and provide that the physician cannot refer patients for certain designated health services to any entity in which the physician has a financial interest.
However, according the qui tam lawsuit filed in 2010 by Dr. Michael Reilly on behalf of the government, Broward Health allegedly over-compensated its employed physicians for referring patients to its facilities. For example, the referring physicians were paid the regular rate for services rendered to their patients, but also allegedly received additional compensation from Broward Health for referring the patients, which resulted in the physicians being illegally compensated at a rate that exceeded the fair market value. The fair market value in health care was designed to regulate the cost of goods and services in order to protect the patient and federal health care programs from being overcharged. Broward Health allegedly knowingly billed Medicare and Medicaid for services in violation of the FCA and settled its claim for $69.5 million without admitting fault.
The FCA is a mechanism used for combatting and discouraging government related fraud. If you have information concerning a potential case involving a company or individual committing health care fraud by overbilling Federal Health Care program, such as Medicare, Medicaid, or Tricare, do not hesitate to take action. It is possible that you might be able to bring your own qui tam lawsuit under the False Claims Act, acting as a whistleblower on behalf of the US government. Before filing your lawsuit, be sure to consult with an attorney familiar with the intricacies of the False Claims Act and qui tam lawsuits, as these attorneys are best equipped to help protect your rights and help you gain your share of any monetary reward from a potential settlement.