On February 10, the Department of Justice announced the indictment of ten individuals in connection with an alleged $300 million healthcare fraud scheme.  The defendants are alleged to have participated in a conspiracy to commit healthcare fraud and pay and receive healthcare kickbacks.  Under the Anti-Kickback laws, individuals are prohibited from paying, receiving, offering, or soliciting monetary payment in exchange for prescribing or ordering treatments, tests, medication, or medical devices for federal healthcare program beneficiaries. 

The federal government alleges that several lab companies paid illegal kickbacks to medical professionals to induce them to order lab tests that were not medically necessary.  The tests were then allegedly billed to federal healthcare programs.  The cost of these tests allegedly totaled millions of dollars.  The labs are alleged to have hidden the kickbacks in medical advisor agreements, leases, and marketing agreements.  The doctors allegedly were paid hundreds of thousands of dollars for services that were never performed, paid the salaries of the doctors’ staff, and paid the doctors’ leases.  If lab orders lagged, the labs allegedly threatened to withhold payments to the doctors.

The labs then allegedly conceived a plan to open a provider-owned lab in order to disguise the kickback program.  Physicians were offered ownership interests if they ordered a minimum number of lab tests.  The labs also allegedly occasionally advanced disbursements to the physicians in order to ensure an adequate number of lab tests.  In total, the labs involved allegedly submitted more than $300 million in bills to federal healthcare programs.  The defendants face as much as 55 years in prison if convicted.

The attorneys at Chilivis Grubman represent clients of all types and sizes in connection with Anti-Kickback Statute and False Claims Act investigations and qui tam litigation.  If you need assistance with such a matter, please contact us today.