"By bringing allegations of fraud to light, whistleblowers play an important role in protecting the integrity of our healthcare system," says the U.S. Attorney for the Western District of Pennsylvania.
He was discussing the role of a whistleblower in a recent case involving violations of the Stark Law, the Anti-Kickback Statute and the False Claims Act. That whistleblower, a former executive vice president at a West Virginia hospital, filed suit against his hospital to bring those violations to light.
The Stark Law prohibits hospitals from forming improper financial relationships with referring physicians and then billing Medicare for services provided on referral from those doctors. Improper financial relationships, generally, are those which incentivize financial decision-making over decisions made in the medical interest of the patient.
The Anti-Kickback Statute is similar in that it prohibits healthcare providers from offers or payment of anything of value in exchange for the referral of services or items covered by a federal healthcare program.
In this case, the Justice Department alleges that Wheeling Hospital, Inc., its contracted management consultant R & V Associates, Ltd., and Wheeling's CEO worked together to provide improper payments to referring physicians in violation of the Stark Law and Anti-Kickback Statute. As evidence, the government points to information that the hospital paid certain physicians compensation that was based on the volume of referrals or their value. It also alleges that some such compensation was above the fair market rate.
"The department is committed to taking action to eliminate improper inducements that can corrupt the integrity of physician decision-making," said an assistant attorney general with the Justice Department's Civil Division.
Indeed, the Justice Department and other responsible agencies have an emphasis on fighting healthcare fraud. In many cases, whistleblowers are entitled to a significant percentage of any money recovered by the government due to their tips.
If you work in healthcare and are considering blowing the whistle on fraud, waste or abuse against government healthcare programs, you should discuss your situation with an experienced lawyer before taking any concrete steps. This can help you avoid retaliation and protect any monetary recovery you may be entitled to receive.