Expose Illegal Dialysis Clinic Kickbacks and Referrals: Medical Professionals Can Earn Large Financial Rewards for Exposing Illegal Dialysis Kickback Schemes and other Forms of Medicare, VA, Tricare, Medicaid, and Federal Benefit Fraud by Dialysis Clinic Kickback Whistleblower Lawyer Jason Coomer
Many large dialysis clinics pay illegal kickbacks to physicians or physician groups for dialysis patient referrals. Further, these lucrative kickback schemes commonly violate the Anti-Kick Statute. More specifically, this federal statute prohibits any person or business entity including dialysis clinics from making or accepting payment to refer Medicare or Medicaid dialysis patients. In fact, the statute prohibits any bribes to induce or reward any person for referring, recommending or arranging for the purchase of any item or service for which payment may be made under a federally-funded health care program. Violations of the Anti-Kickback Statute can be the basis of whistleblower lawsuits that pay large rewards to medical professionals who properly expose illegal schemes. Medical professionals are encouraged to report illegal dialysis kickback and referral schemes through a Dialysis Clinic Kickback Whistleblower Lawyer. The lawyer can explain whistleblower reward laws and whistleblower protections as well as help investigate and prepare a case.
If you are a medical professional who is aware of illegal kickbacks, bribes, inducements, rewards, or other economic incentives being paid by dialysis clinics to physicians for referrals of Tricare, Veterans' Administration (VA), Medicaid, or Medicare patients, please report the illegal actions. Further, if you are interested in a confidential review of a potential whistleblower reward case, please feel free to contact Dialysis Clinic Kickback Whistleblower Lawyer Jason Coomer via e-mail message. Alternatively, please also feel free to use our submission form. Either way, you can request information about whistleblower rewards and whistleblower protections for reporting an illegal dialysis kickback scheme.
Through the Federal False Claims Act The United States Has Recovered Over $62 Billion
Since 1986, the Civil Division of the Department of Justice, working with U.S. Attorneys across the country, has returned tens of billions of dollars to the federal Treasury through civil and criminal judgments and resolutions in affirmative cases. This amount includes more than $62 billion recovered by the Division and the U.S. Attorneys under the False Claims Act. Last year alone, the government recovered more than $4.7 billion under the Act the seventh straight year that the Department has recovered more than $3 billion of taxpayer funds. Similarly, in each of the last seven fiscal years, the governments health care fraud recoveries have equaled or exceeded $2 billion. In addition, in FY 2016, the government recovered more than $6.6 billion from banks and other financial institutions making false statements and claims.
Dialysis Clinic Kickback Whistleblowers Can Earn Large Financial Rewards of Between 15% to 30% of Money Recovered by the Federal Government
Medicaid, Tricare, Veterans Administration, Hospice, and Medicare Whistleblowers who provide original source information of schemes to fraudulently take money from our United States government including illegal kickbacks, bribes, upcoding, double billing, bill padding, unbundling, and charging for services never provided may recover a portion of the proceeds recovered on the government's behalf. Awards to whistleblowers through the Federal False Claims Act can range from 15% to 30% of any settlement or recovery made by the government. Moreover, if the Government intervenes in the action, the whistleblower's award can range from at least 15% but not more than 25% of the proceeds of the action or settlement of the claim plus reasonable attorneys fees and costs. If the Government does not intervene in action, the person bringing the action or settling the claim shall receive an amount which the court decides is reasonable for collecting the civil penalty and damages. The amount shall be not less than 25% and not more than 30% of the proceeds of the action or settlement and shall be paid out of such proceeds plus reasonable attorneys fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.
DaVita to Pay $350 Million to Resolve Allegations of Illegal Kickbacks DOJ Press Release October 22, 2014
DaVita Healthcare Partners, Inc., one of the leading providers of dialysis services in the United States, has agreed to pay $350 million to resolve claims that it violated the False Claims Act by paying kickbacks to induce the referral of patients to its dialysis clinics, the Justice Department announced today. DaVita is headquartered in Denver, Colorado and has dialysis clinics in 46 states and the District of Columbia.
The settlement today resolves allegations that, between March 1, 2005 and February 1, 2014, DaVita identified physicians or physician groups that had significant patient populations suffering renal disease and offered them lucrative opportunities to partner with DaVita by acquiring and/or selling an interest in dialysis clinics to which their patients would be referred for dialysis treatment. DaVita further ensured referrals of these patients to the clinics through a series of secondary agreements with the physicians, including entering into agreements in which the physician agreed not to compete with the DaVita clinic and non-disparagement agreements that would have prevented the physicians from referring their patients to other dialysis providers.
Anti-Kickback Statute Promotes Superior Quality Medical Services and Prohibits Illegal Bribes and Kickbacks
Health care providers should generate business by offering their patients superior quality services or more convenient options, not by entering into contractual agreements designed to induce physicians to provide referrals, said Deputy Assistant Attorney General for the Justice Departments Civil Division Jonathan F. Olin. The Justice Department is committed to protecting the integrity of our healthcare system and ensuring that financial arrangements in the healthcare marketplace comply with the law.
The government alleged that DaVita used a three part joint venture business model to induce patient referrals. First, using information gathered from numerous sources, DaVita identified physicians or physician groups that had significant patient populations suffering renal disease within a specific geographic area. DaVita would then gather specific information about the physicians or physician group to determine if they would be a winning practice. In one transaction, a physicians group was considered a winning practice because the physicians were young and in debt. Based on this careful vetting process, DaVita knew and expected that many, if not most, of the physicians patients would be referred to the joint venture dialysis clinics.
Dialysis Clinics Commonly Target Physicians and Physician Groups With Fraudulent Schemes
Next, DaVita would offer the targeted physician or physician group a lucrative opportunity to enter into a joint venture involving DaVitas acquisition of an interest in dialysis clinics owned by the physicians, and/or DaVitas sale of an interest in its dialysis clinics to the physicians. To make the transaction financially attractive to potential physician partners, DaVita would manipulate the financial models used to value the transaction. For example, to decrease the apparent value of clinics it was selling, DaVita would employ an assumption it referred to as the HIPPER compression, which was based on a speculative and arbitrary projection that future payments for dialysis treatments by commercial insurance companies would be cut by as much as half in future years. These manipulations resulted in physicians paying less for their interest in the joint ventures and realizing returns on investment which were extraordinarily high, with pre-tax annual returns exceeding 100 percent in some instances.
Last, DaVita ensured future patient referrals through a series of secondary agreements with their physician partners. These included paying the physicians to serve as medical directors of the joint venture clinics, and entering into agreements in which the physicians agreed not to compete with the clinic. The non-compete agreements were structured so that they bound all physicians in a practice group, even if some of the physicians were not part of the joint venture arrangements. These agreements also included provisions prohibiting the physician partners from inducing or advising a patient to seek treatment at a competing dialysis clinic. These agreements were of such importance to DaVita that it would not conclude a joint venture transaction without them.
Fraudulent Joint Ventures Arrangements With Dialysis Clinics Can Be Used to Conceal Kickback Schemes
The Government's complaint identifies a joint venture with a physicians group in central Florida as one of several examples illustrating DaVita scheme to improperly induce patient referrals. The group had previously been in a joint venture arrangement involving dialysis clinics with Gambro, Inc., a dialysis company acquired by DaVita in 2005. Prior to the acquisition, Gambro had entered into a settlement with the United States to resolve alleged kickback allegations that, among other things, required Gambro to unwind its joint venture agreements. As a consequence, Gambro purchased the groups interest in the joint venture clinics and agreed to a carve-out of the associated non-competition agreement which allowed the group to open its own dialysis clinic nearby, which it did. After acquiring Gambro, DaVita bought a majority position in the groups newly established dialysis clinic, and sold a minority position in three DaVita-owned clinics. Despite the fact that each of the clinics involved were roughly comparable in terms of size and profits, DaVita agreed to pay $5,975,000 to acquire a 60 percent interest in the groups clinic, while selling a 40 percent interest in the three clinics it owned for a total of $3,075,000. As part of this joint venture, the group agreed to enter into new non-compete agreements.
This case involved a sophisticated scheme to compensate doctors illegally for referring patients to DaVitas dialysis centers. Federal law protects patients by making buying and selling patient referrals illegal, so as to ensure that the interest of the patient is the exclusive factor in the referral decision, said U.S. Attorney John Walsh. When a company pays doctors and/or their practice groups for patient referrals, the companys focus is not on the patient, but on the profit to be extracted from providing services to the patient.
The U.S. Attorneys Office and DaVita agreed to a Civil Forfeiture in the amount of $39 million based upon conduct related to two specific joint venture transactions entered into in Denver, Colorado. Additionally, DaVita has entered into a Corporate Integrity Agreement with the Office of Counsel to the Inspector General of the Department of Health and Human Services which requires it to unwind some of its business arrangements and restructure others, and includes the appointment of an Independent Monitor to prospectively review DaVitas arrangements with nephrologists and other health care providers for compliance with the Anti-Kickback Statute.
Anti-Kickback Statutes and Whistleblower Reward Laws Target Illegal Kickback Schemes
Companies seeking to boost profits by paying physician kickbacks for patient referrals undermines impartial medical judgment at the expense of patients and taxpayers. For this reason, the government encourages healthcare providers to expose these illegal schemes and works with whistleblowers to investigate and expose such wasteful business arrangements.
The Devitas settlement resolves allegations originally brought in a lawsuit filed under the qui tam or whistleblower provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government and to share in any recovery. The suit was filed by David Barbetta, who was previously employed by DaVita as a Senior Financial Analyst in DaVitas Mergers and Acquisitions Department. Mr. Barbettas share of the recovery has yet to be determined.
This settlement illustrates the governments emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $22.4 billion through False Claims Act cases, with more than $14.2 billion of that amount recovered in cases involving fraud against federal health care programs.
The Anti-Kickback Statute and the Stark Statute
The Stark Statute is named after California Rep. Pete Stark who authored this legislation. The purpose of the law is to prohibit physician self-referrals and prevents a physician from referring patients for certain designated health services to any entity with which the physician has a financial interest.. The law applies to any physician who provides care to Medicare or Medicaid and is not as broad as the Anti-Kickback Statute.
The Anti-Kickback Statute and Stark Statutes are separate statutes, but are also refer to one another, sometimes making compliance with one contingent on complying with the other. Both are intended to prevent health care providers from making referrals for the purpose of financial benefit to themselves instead of for the patient's benefit.
For more information on the Stark Statute or Federal False Claim Lawsuits from violations of the Stark Statute, go to the following webpage on Stark Statute Violation False Claim Lawsuits.
Whistleblower Protection Under the Federal False Claims Act
The Federal False Claims Act has strong whistleblower protection provisions that protect Qui Tam False Claims Act whistleblowers from retaliatory actions by violators of the Federal False Claims Act.
Under Section 3730(h) of the False Claims Act, "[a]ny employee who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment by his or her employer because of lawful acts done by the employee on behalf of the employee or others in furtherance of an action under this section, including investigation for, initiation of, testimony for, or assistance in an action filed or to be filed under this section, shall be entitled to all relief necessary to make the employee whole. Such relief shall include reinstatement with the same seniority status such employee would have had but for the discrimination, 2 times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys' fees. An employee may bring an action in the appropriate district court of the United States for the relief provided in this subsection."
For more information on Whistleblower Protection Under the Federal False Claims Act or other Federal Whistleblower Protections, please go to the following Whistleblower Protection Webpage.
Government Contractor Fraud Qui Tam Whistleblower Lawsuit Information (False Claims Act Whistleblower Qui Tam Action Information)
For more information on Medicare Fraud, Tricare Fraud, Medicaid Fraud, Defense Contractor Fraud, Off Label Fraud, Road Construction Fraud, and other types of False Claims Act Whistleblower Claims, please go to the Qui Tam, Whistleblower, and Federal Federal False Claims Act Information Center.
Dialysis Kickback Whistleblower Lawyers Work on Dialysis Kickbacks Involving Tricare, Veterans' Administration, Medicaid, and Medicare Fraud
Medical Professionals and Dialysis Patient who are aware of dialysis kickback schemes should report the fraud. More specifically, they should report the illegal kickbacks through a dialysis kickback whistleblower lawyer. The dialysis kickback lawyer can provide information on whistleblower rewards and whistleblower protections. The lawyer can also investigate and help prepare evidence to properly report and expose the kickback scheme. It is important to expose large health care companies who defraud the United States Government, Tricare, Medicare, Veterans' Administration (VA), or Medicare out of millions or billions of dollars. For more information on this topic to have a case reviewed, Dialysis Clinic Kickback Whistleblower Lawyer Jason Coomer via e-mail message. As a Dialysis Whistleblower Lawyer, his firm commonly works with other lawyers throughout the United States whistleblower cases that expose systematic fraud that hurts the United States.
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