Last week was an expensive one for Gary Newsome.
On April 30, the Department of Justice announced that he has agreed to pay nearly $3.5 million to settle false billing and kickback claims from when he served as CEO of Health Management Associates between 2008 and 2013. Federal prosecutors alleged that Newsome directly pressured his emergency room physicians to increase admissions when many patients could have been treated in less expensive outpatient facilities.
In their press release, the Department of Justice stated:
“Patients deserve the unfettered, independent judgment of their health care professionals. We will pursue those who cause hospitals to offer financial incentives to physicians in return for improper patient referrals that undermine the integrity of our health care system.”
“Providers are expected to closely follow rules and bill properly. Further, in this case, the government contended that Newsome directed illegal payments for referrals,” said Derrick L. Jackson, Special Agent in Charge of the Office of Inspector General of the U.S. Department of Health and Human Services.”
The Department of Justice is enforcing individual responsibility for corporate wrongdoing, and Newsome is just the latest example. Make no mistake - the government can and will come after you individually for Stark, Anti-Kickback and False Claims violations in addition to your hospital or health system. If you aren’t clearly defining, determining and documenting Fair Market Value for your physicians or if you’re routing patients to the wrong departments to increase costs, you could be next.
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