Vascular Access Centers L.P., along with 23 subsidiaries and related corporations, has been accused of Medicare fraud, violating the False Claims Act, and violating the Anti-Kickback Statute and have agreed to pay at least $3,825 million to resolve the allegations. If certain contingencies arise, additional payments up to $18,360,794 could be triggered.
The allegations originated from two whistleblower lawsuits under the False Claims Act, which allows private individuals to file lawsuits on behalf of the government in cases of fraud, waste and abuse in federal contracting. In successful cases, the whistleblowers receive a percentage of any money recovered as a reward for their service. In this case, the two whistleblowers will share a minimum of $612,000.
The companies, collectively referred to as "VAC," are accused of billing Medicare for vascular access procedures that were not reimbursable. These procedures were performed on end stage renal disease (ESRD) patients without the required documentation of the medical necessity of the procedures. The procedures performed included such things as fistulagrams and percutaneous transluminal angioplasties.
In addition, VAC allegedly billed Medicare for services resulting from improper referrals. These referrals were gained by improperly remunerating medical directors and physician investors in violation of the Anti-Kickback Statute. That law is meant to ensure that improper financial incentives do not influence doctors' medical judgment, which should be based on the patient's best interest.
Beyond paying a minimum of $3.825 million to reimburse the government for these false claims, VAC has agreed to enter into a corporate integrity agreement which requires it to undertake significant compliance efforts, including a focus on Anti-Kickback-Statute compliance, over the next five years.
"Medicare patients with End Stage Renal Disease, like other beneficiaries, are entitled to receive care in accordance with their clinical needs and not based on the financial interests of healthcare providers," said the Assistant Attorney General for the Department of Justice's Civil Division. "Entities and individuals that attempt to profit through improper financial incentives and thereby bypass independent clinical decision-making will be held accountable."
Healthcare workers often notice fraud and abuse in Medicare, Medicaid, TRICARE and other government-funded healthcare programs. If you work in healthcare or another industry where government contracts are common, you may be in a position to blow the whistle -- and you could receive a substantial reward for your service. However, you should protect your rights and any potential recovery by discussing your situation with an attorney familiar with False Claims Act and whistleblower cases.