The Department of Justice announced Monday that it has intervened in a False Claims lawsuit against Infirmary Health System. At issue in the suit is an arrangement that existed between a subsidiary of Infirmary Health System, IMC-Diagnostics & Medical Clinic, through which Medicare was billed for services referred by Diagnostic Physicians Group. The Justice Department alleges that the practice violates the Stark Act and Anti-Kickback Statute.
In an effort to prevent physicians from turning patients into commodities to be traded for profit and at the expense of American taxpayers, the Stark Act and Anti-Kickback statutes were established. These laws make it illegal for physicians to refer Medicare and Medicaid recipients to institutions in which the referring physician has a financial interest.
“The relationship between a patient and their physician is sacrosanct. Every effort must be made to protect the confidence patients have in their physician. Conflicts of interest can corrupt that relationship, and may influence a physician’s decisions about a patient’s care,” commented Christopher Paulos, an attorney with the Levin, Papantonio law firm who practices in the areas of whistleblower, personal injury, product liability and defective drug litigation.
The case Infirmary Health System case was brought forward under the qui tam, or whistleblower, provisions of the federal False Claims Act by Dr. Christian Heesch, a physician with Diagnostic Physicians Group in 2011.
“Unfortunately, direct financial relationships between a doctor and other healthcare entities to which that doctor is financially motivated to make referrals has been shown to lead to rampant overtreatment of patients. The patient may be the last person to know why a doctor is actually making the referral,” Mr. Paulos continued. “Often, it takes the courageous action of an insider to come forward and expose these improper relationships.”
The federal False Claims Act provides incentives and rewards for individuals that come forward to expose instances and occurrences of entities defrauding the government. According to the Department of Justice, since 2009 the DOJ has recovered more than $14.7 billion due in part to the efforts of whistleblowers through the Act.
Mr. Paulos said, “protecting patient confidence and American taxpayers from fraud is very important. The efforts of whistleblowers and the provisions of the False Claims Act are powerful tools that can be used to combat such corruption.”
Joshua is a writer and researcher with Ring of Fire.