Like 2015, there were quite a number of settlements regarding improper payments to physicians in 2016. Some notable examples are:
Tenet Healthcare Corporation: $513 million
The DOJ charged two of Tenet’s Atlanta-area hospitals with paying kickbacks in exchange for physician referrals. The DOJ found that Tenet used bribes to a prenatal clinic in order to refer more than 20,000 pregnant women to Tenet hospitals. The DOJ cites that not only were these payments illegal, they also took advantage of disadvantaged women in a system that is meant to protect them. Read more here.
Lexington Medical Center: $17 million
This case underscores the need to ensure that referring physicians do not gain financially from the referral of beneficiaries from government programs for tests or other procedures. Lexington Medical Center employed or acquired medical practices for 28 physicians in a manner which was above FMV or took into account the value or volume of referrals to hospital programs, thereby violating Stark law. Read more here.
Sacred Heart Hospital Executives and Physicians: Jailed and Fined
Sacred Heart Hospital in Chicago closed in 2013 following discovery of a kickback scheme that involved numerous physicians and administrators. One physician was sentenced to two years in prison and fined $786,000. Ten defendants, including the hospital CEO and owner, were sent to prison and fined in the elaborate Medicare fraud scheme. The CEO faced fines in excess of $10 million. This is an extreme example of the risk individual physicians and administrators can face for illegal arrangements between hospitals and providers. Read more here.
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