When it comes to complying with Stark Law and the Anti-Kickback Statute, it can often be hard to keep all your ducks in a row and maintain a perfect compliance program. However, with some recently released DOJ allegations, healthcare organizations can directly learn exactly what not to do when it comes to Stark and AKS:
The Department of Justice alleges that nonprofit Wheeling Hospital Inc. violated the Stark Law and Anti-Kickback Statute, and that those violations were caused by R V Associates Ltd., Wheeling's contracted management consultant, and Wheeling CEO Ronald Violi, who prosecutors allege had "dictatorial control" of the compensation agreements..."Wheeling Hospital's dramatic revenue increase was accomplished by entering into lucrative but improper compensation arrangements with physicians that were well above fair market value, took into account the value or volume of services and/or were not commercially reasonable, in order to gain the physicians' referrals," the suit claims. - Health Leaders Media
Sometimes well-meaning hospitals can make mistakes in the complex world of healthcare compliance - but sometimes bad actors can helpfully provide the roadmap of precisely what you should not be doing in your physician contracting program. Stark law directly prohibits a hospital from billing Medicare for services referred by physicians who have improper financial relationships with the hospital which appears to be exactly what the alleged behavior involved.
Interestingly, the DOJ lawsuit was once again filed under the qui tam, or whistleblower, provisions of the False Claims Act. Whistleblower laws mean that organizations must maintain compliant behavior in the realm of physician contracting at all times - no matter how good their intentions may be- or face the potential risk of expensive settlements for compliance violations in the future.
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