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Volume XI, Number 268

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Paying for Patients Results in Health System Settling for $21 Million under False Claims Act

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.

© 2021 by Tycko & Zavareei LLPNational Law Review, Volume XI, Number 189
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About this Author

Eva Gunasekera WHistleblower and Government Fraud  Attorney Tycko & Zavareei LLP Law Firm
Partner

FORMER DOJ SENIOR COUNSEL FOR HEALTH CARE FRAUD, NOW REPRESENTING WHISTLEBLOWERS

(202) 973-0900
Renée Brooker Whistleblower Lawyer Tycko & Zavareei Law Firm
Partner

FORMER PROSECUTOR IN SENIOR LEADERSHIP POSITION AT DOJ, RESPONSIBLE FOR BILLIONS OF DOLLARS IN RECOVERIES UNDER WHISTLEBLOWER LAWS, NOW REPRESENTING WHISTLEBLOWERS

(202) 417-3664‬
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