Let’s try this. What if you went to your doctor with a health problem,
and he told you he knew about a machine that could help you. You dutifully
went through treatments with this medical device that your doctor said
would help you. Medicare got charged for the treatments, and of course
you had to pay the co-pay. But then — you found out that the FDA
had never approved the product for patients who had your condition.
Now add this fact: you discover that your doctor was getting kickbacks
from the product manufacturer. Every time the doctor used the machine
on one of his patients, the product manufacturer paid the doctor.
How about now — are you incensed yet? You have the right to be!
How could you ever trust that doctor again?
You may be thinking that this scenario sounds far-fetched. If only! According
to allegations from the Government, that case really happened. Fortunately,
a whistleblower, a former sales representative for the manufacturer of
the device, brought suit under the False Claims Act to alert the Government
to what was happening. The medical device company never admitted liability,
but it settled the claims for half a million dollars during the Government’s
fiscal year 2014.
The healthcare system is based on trust; when a doctor makes healthcare
decisions based on how much he will get paid, instead of on what the patient
actually needs, the entire healthcare system gets undermined. To stop
these sorts of practices, Congress passed the Anti-Kickback Statute (AKS),
which makes it illegal to pay to drum up healthcare business. Shockingly,
during the Government’s fiscal year 2014, nearly 15% of all qui
tam (whistleblower) cases involved allegations that someone in the healthcare
industry was violating the Anti-Kickback statute. I am writing a series
of blogs describing real examples of Anti-Kickback cases filed under the
False Claims Act. In my view, these cases are particularly appalling because
they erode the very foundation of the healthcare system – the trust
that a patient places in a doctor.