On September 15, 2015, the Department of Justice (DOJ) announced that Broward Health, an operator of more than 50 health care facilities in South Florida, agreed to pay $69.5 million to settle False Claims Act allegations. Broward Health violated the Federal Stark Law and Anti-Kickback Statute by allegedly overcompensating referring physicians for services to cover up illegal kickbacks for patient referrals.
Broward County, the area covered by Broward Health, includes the major cities of Fort Lauderdale and Hollywood. Broward Health is a public hospital system. It’s actual name is North Broward Hospital District.
Exposing the Illegal Scheme.
According to the federal Stark Law and the Anti-Kickback Statute, it is illegal for health care providers to knowingly accept forms of compensation in return for referrals that result in claims paid by Medicare and Medicaid. These laws are implemented to protect patients and health care programs, such as Medicare and Medicaid, from fraud and abuse.
A former employee and whistleblower in this case, exposed Broward’s illegal practices by filing a qui tam case in 2010 under the False Claims Act (FCA). The FCA is the federal government’s primary litigation tool in combating fraud against the government. If Broward Health’s offer is accepted, the whistleblower stands to collect more than $12 million.
Physicians Illegally Compensated.
According to the qui tam suit filed in 2010, Broward Health allegedly overcompensated its physicians for referring patients to its health care facilities. The referring physicians were paid the regular rate for services rendered, but also allegedly received additional compensation that exceeded fair market value.
If the offer to the U.S. government is accepted, Broward Health would become the second largest hospital system in Florida to pay a substantial amount for engaging in improper financial relationships with its physicians. “Improper financial rewards given to physicians in exchange for patient referrals corrupts medical decision making and inflates health care costs,” said Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG).
Fighting Government Fraud and Abuse.
This case was brought under the federal False Claims Act or “whistleblower law.” This law contains standards for both civil and criminal penalties against those falsely billing the government. False Claims Act cases, such as this recent one, are typically filed in a qui tam (or whistleblower) proceeding. This type of action involves a private party filing a lawsuit against a defendant who allegedly is defrauding the government. The “whistleblower” receives a percentage of the money recovered by the government, often millions of dollars. Usually, these types of cases protect the whistleblowers from receiving any potential prosecution or punishment due to involvement in the fraudulent actions.
Our firm has been on both sides of whistleblower or qui tam cases. We have defended physicians, medical groups and health facilities. But, we have also represented relators or plaintiffs bringing such actions to recover money on behalf of the government. A qui tam relator can receive up to 30% of the amount recovered on behalf of the government.
If you have information concerning health care fraud by overbilling federal health care programs such as Medicare or Medicaid, do not hesitate to take action. The government urges health care providers to step forward and report illegal and fraudulent activities as soon as they are uncovered. The False Claims Act provides a system of rewards that encourages whistleblowers to bring these issues to the government’s attention.
Sources:
The National Law Review. “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.” (September 17, 2015). Web.
Christensen, Dan. “Broward Health offers nearly $70 million to settle fraud case.” Sun Sentinel. (August 24, 2015). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620. www.TheHealthLawFirm.com
“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2015 The Health Law Firm. All rights reserved.
