My law firm is looking to hire someone. Our ideal candidate does not need
any particular skills or training. The person does not need to be motivated
and will not be expected to work regular hours. Or any hours. Actually,
the person does not even need to show up. It will not be necessary for
the person to check in, fill out a time card, or anything else. Obviously
we recognize that we’re going to have to pay top dollar to find
someone to fill a post like this.
I think you can guess that this is not a serious job post! What right-minded
employer would offer a job like that?! Well how about . . .
A hospital? In two Stark Act cases, hospitals have been accused of giving
cushy, non-work jobs to doctors or their family members, figuring the
favor would persuade the doctor to send business to the hospital. Problem
is: that’s illegal.
Under the Medicare program, the Government pays for healthcare for older
Americans. The Stark Act says that the Government should not have to pay
for bribes and “incentives” that get wrapped into the costs
of the healthcare. If a hospital wants more patients, it should earn them
the old-fashioned way — by providing great healthcare and making
people want to use its services. Asking doctors to make medical decisions
based on their own pocketbooks — not on patients’ best interests
— is against every principle Medicare is interested in fostering,
or that we as a society want.
I’m in a series on False Claims Act cases that settled or tried in
the Government’s fiscal year 2014.
A Plus Home Health Care Inc., Tracy Nemerofsky and Stephen Nemerofsky – $1.65 million
In September 2014, the Department of Justice announced it had reached
a settlement with A Plus Home Health Care, Inc., of Fort Lauderdale, Florida.
The home health agency and its owners, a father-daughter team, agreed
to pay the U.S. $1.65 million. A whistleblower who had been a director
of development at the home care agency filed suit under the FCA, notifying
the Government about a kickback scheme at A Plus. According to DOJ, the
home health agency tried to drum up business by hiring doctor’s
spouses plus one doctor’s boyfriend. DOJ observed that the Stark
Act bans all kickbacks to physicians, even if they follow a circuitous
route into the doctors’ pockets. In addition to settling with the
hospital, DOJ also settled with at least five of the doctors and their spouses.
Community Health Systems Inc. – $98.15 million
A mega-owner of acute care hospitals was sued numerous times by whistleblowers
alleging that Community Health Systems, Inc., was hospitalizing patients
for inpatient treatment, when the patients could have been treated with
outpatient or observation services. The acute care hospital system, which
has 206 hospital affiliates spread across 29 states, also was accused
of admitting patients who came to the emergency room, even when the patients
did not have to be treated on an inpatient basis. The whistleblowers alleged
that the practice drove up costs for Medicare, Medicaid and TRICARE, which
is the program for military personnel through the Department of Defense.
While the unnecessary inpatient treatment received the most publicity,
the case also involved allegations that the hospital had violated the
Stark Act. One of the hospitals, LMC in Laredo, Texas, was accused of
making a physician a medical director at the hospital in order to induce
him to refer patients to the hospital. Community Health paid $9 million
for that the Stark Act claim. Stuart F. Delery, Assistant Attorney General
for the Justice Department’s Civil Division, said that: “providing
physicians with financial incentives to refer patients compromises medical
judgment and risks depriving patients of the most appropriate health care
available.”
The case involved numerous relators (whistleblowers). While all had been
employees of Community Health at one point, none worked for the hospital
system by the time of settlement. The relators had held a variety of jobs.
A former Director of Health Information Management as well as a nurse
from the Shelbyville, Tennessee, hospital blew the whistle on that facility.
Another nurse reported fraud at the Dyersburg, Tennessee, facility. An
Emergency Medical Services Coordinator came forward with information about
the Marion, Illinois, facility. A coder from the Laredo, Texas hospital,
brought suit. An internal medicine and emergency room physician who had
been with one of the company’s hospitals in Philadelphia filed under
the False Claims Act, as did an ER physician from the Mooresville, North
Carolina facility and an ER doctor who had been in Longview, Texas. A
nurse and Supervisor of Case Management from the Fort Wayne, Indiana,
unit of the company came forward as well.