Three physicians separately entered deals with the US government to settle allegations that they received improper payments and caused false claims to be submitted to Medicare, United States Attorney Scott W. Brady announced May 8. The allegations remain as such, but the three physicians involved will pay a combined total of $700,000.
Dr. Robert Fetchero, D.O., of Jeannette, Pennsylvania, Dr. Sridhar Pinnamaneni, M.D., of Windermere, Florida, and Dr. Thelma Green-Mack, M.D., of Zionsville, Indiana, referred Medicare patients to Universal Oral Fluid Laboratories (“UOFL”) for drug testing services while allegedly engaged in a financial relationship with the lab. Another doctor who pled guilty on related charges had already begun his 80-month jail sentence in July last year.
Because of the so-called financial relationship between these physicians and UOFL, the latter was able to send claims to Medicare for drug testing services from 2011 to 2014. UOFL paid the involved physicians to refer their patients to the lab for drug tests. The United States alleged that the financial arrangement between the settling physicians and UOFL violated the physician self-referral law, commonly known as the “Stark Law,” and the Anti-Kickback Statute. This, in turn, gave rise to liability under the False Claims Act.
The Stark Law forbids physicians from referring certain health services payable by Medicare to providers that he or she (or an immediate family member) has a financial relationship with, unless an exception applies. The Anti-Kickback Statute bars them from offering, paying, soliciting, or receiving payment to induce referrals of services covered by federal health care programs, such as Medicare. Violating the Stark Law or Anti-Kickback Statute can result in damages and penalties under the False Claims Act that are up to three times the payment earned from the scheme.
“A physician’s medical judgment should never be compromised by improper financial incentives,” said United States Attorney Scott W. Brady in a statement.
The False Claims Act is a powerful statute that enables courageous individuals with inside information to essentially blow the whistle and potentially receive a whistleblower award up to 30% of what the government recovers. Under the Federal False Claims Act the cases must have some sort of nexus to the Federal government – either overbilling or falsely billing Medicare or Medicaid for example. Certain states like California and Illinois permit the recovery for frauds against private insurance companies as well.
If you know of similar arrangements leading to false claims to Medicare, take the first step to correct it. Call Toll Free (877) 561-0000.