The relationship between health care and money is the crux of some of the biggest policy debates of our time. Still, while much is debated, there are also many principles that most Americans agree should hold true. One such maxim – Medical decisions should be based on the best interests of patients, not providers own financial well-being. This precept is reflected in several laws including the Anti-Kickback Statute and the Stark Act and enforcing these rules is one of the goals of our work as a whistleblowers’ law firm for health care fraud issues.
$115 Million Settlement Resolves Case Alleging Health System’s Bonuses Violated Law
Just last week, the Justice Department (“DOJ”) announced a major settlement in a health care fraud case involving allegations of improper financial relationships between health care providers and their referral sources. The lawsuit claimed that Adventist Health Systems, a healthcare organization with facilities in 10 states, billed for the services of employed providers who were paid bonuses that, contrary to law, were based on a formula that considered the value of the referrals to the hospital system. More specifically, the suit alleged that doctors received monetary bonuses tied to the number of tests and procedures they ordered. Adventist agreed to pay $115 million to settle these and other fraud allegations, but did not admit to any wrongdoing.