In recent weeks, the federal government has made clear that it will be devoting more time and resources going after individual physicians for potential fraud, waste, and abuse. On June 9, for example, the HHS Office of Inspector General (“OIG”) issued a Fraud Alert warning physicians that entering into compensation arrangements such as medical directorships without ensuring that those arrangements reflect fair market value for bona fide services actually provided may result in significant liability, including criminal, civil and administrative sanctions. The alert states that, although many compensation arrangements are legitimate, “a compensation arrangement may violate the anti-kickback statute if even one purpose of the arrangement is to compensate a physician for his or her past or future referrals of Federal health care program business.” The alert goes on to encourage physicians to “carefully consider the terms and conditions of medical directorships and other compensation arrangements before entering into them.”
Next, on June 18, federal and state officials announced a nationwide takedown of 243 individuals on charges related to over $700 million in allegedly false Medicare billings, the largest action to date by the Medicare Fraud Strike Force, which has been in existence since 2007. Many of those arrested and charged were doctors, nurses, and other licensed medical professionals. Some of those arrested were charged with violations of the Anti-Kickback Statute.
Most recently, on July 1, at a healthcare conference attended by Chilivis Grubman attorney Scott Grubman, OIG announced that it is hiring approximately ten additional attorneys for a new litigation team focused exclusively on cases brought under the civil monetary penalties law, the False Claims Act, the Anti-Kickback Statute, and the OIG’s authority to exclude providers from federal health programs. The OIG stated that the new team will bring cases related to guidance issued by the OIG, including the June alert discussed above.
These recent events should serve as stern and clear reminders to physicians and other healthcare professionals that the government is focused in on potential violations of the rules and regulations governing Medicare and Medicaid, and will continue to devote time and money to find and punish those who violate those rules. In particular, physicians must make sure that any compensation arrangement with an entity to which that physician refers federal health care program beneficiaries complies with the Stark law and the Anti-Kickback Statute. At Chilivis Grubman, we work with fair market value consultants who can help assure that any such compensation arrangement is Stark and AKS compliant. For more information, please contact attorney Scott Grubman at (404) 262-6505 or firstname.lastname@example.org.