"Patients and taxpayers rightly should expect that referrals be based on sound medical judgement, not driven by thinly veiled bribes, as alleged here," said a spokesperson for the U.S. Department of Health and Human Services Office of Inspector General.
"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.
When someone blows the whistle on fraud, waste or abuse in federal programs, they can often receive as a reward a substantial portion of any money recovered on behalf of the government. This is called the qui tam provision of the federal False Claims Act. In a recent pair of consolidated False Claims Act cases, the whistleblower will receive a reward of $5,411,521.
The federal government intervened in eight False Claims Act lawsuits and brought criminal charges against Health Management Associates, LLC (HMA), a hospital chain that has since been sold. According to the Justice Department, HMA engaged in a scheme to defraud the U.S. The allegations include:
It has been reported that Post Acute Medical, LLC, and certain affiliates ("PAM") have agreed to pay $13,168,000 to settle claims by the Justice Department, Texas and Louisiana that they violated the False Claims Act and parallel state statutes. The nationwide operator of rehabilitation and long-term care hospitals was accused of knowingly submitting claims to Medicare and Medicaid that were the result of violations of the Physician Self-Referral Law and the Anti-Kickback Statute.
Florida-based 21st Century Oncology provides integrated cancer care. It owns and operates affiliates and subsidiary clinics throughout the U.S., with doctors specializing in fields such as medical oncology, radiation oncology and urology. It has just settled two cases with the Justice Department for $26 million.