Akron General Health System (AGHS), a regional hospital system based in Akron, Ohio, will pay $21.25 million to resolve allegations under the False Claims Act of improper relationships with certain referring physicians, resulting in the submission of false claims to the Medicare program. AGHS was acquired at the end of 2015 by the Cleveland Clinic Foundation (Clinic) through a full member substitution agreement.
This settlement resolves allegations that between August 2010 and March 2016, AGHS paid compensation substantially in excess of fair market value to area physician groups to secure their referrals of patients, in violation of the Anti-Kickback Statute and the Physician Self-Referral Law, and then submitted claims for services provided to these illegally referred patients, in violation of the False Claims Act. The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs.
The Physician Self-Referral Law, commonly known as the Stark Law, prohibits a hospital from billing Medicare for certain services referred by physicians with whom the hospital has an improper financial arrangement, including the payment of compensation that exceeds the fair market value of the services actually provided by the physician. The Clinic voluntarily disclosed to the government its concerns with these compensation arrangements, which were put in place by AGHS’s prior leadership, and received credit for its cooperation in the resolution reached by the parties.
“Improper payments to physicians for referrals threaten the integrity of our health care system and deprive patients of the independent medical decision making that they deserve,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “The Justice Department is committed to upholding these important interests and to pursuing providers who engage in improper financial arrangements.”
“Medical decisions should be made with a patient’s best interest in mind rather than an illegal financial agreement,” said Acting U.S. Attorney Bridget M. Brennan for the Northern District of Ohio. “This office is committed to taking appropriate action to ensure the integrity of federal healthcare programs.”
“Physicians must make referrals and other medical decisions based on what is best for patients, not to serve profit-boosting business arrangements,” said Special Agent in Charge Lamont Pugh III of HHS-OIG. “Working closely with our law enforcement partners, we will continue to protect taxpayer-funded federal health care programs as well as patients.”
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Beverly Brouse, the former Director of Internal Audit at AGHS, and Ethical Solutions LLC. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States ex rel. Brouse et al. v. Akron General Health System, Inc. et al., No. 5:15-cv-2720 (N.D. Ohio).
The resolution obtained in this matter was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch and Fraud Section, the U.S. Attorney’s Office for the Northern District of Ohio, HHS-OIG, and the FBI.
The investigation and resolution of this matter illustrate the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to HHS at 800-HHS-TIPS (800-447-8477).
The matter was investigated by Trial Attorney Christopher Wilson of the Civil Division and Assistant U.S. Attorney Patricia M. Fitzgerald.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.