Doctor to Receive $4.4 Million Whistleblower Reward in Alabama Hospital Suit By Tod Aronovitz | 08/11/14 | 0 Comment

An Alabama hospital system, two of its affiliated clinics and one physician group have agreed to settle a $24.5 million lawsuit alleging that they paid or received financial inducements in violation of the False Claims Act, the Justice Department recently announced.

Infirmary Health System Inc. (IHS), IMC-Diagnostic and Medical Clinic, IMC-Northside Clinic, and Diagnostic Physicians Group P.C. (DPG) allegedly billed Medicare for certain services referred by physicians who had a financial relationship with the health system, a relationship that is prohibited under the Stark Law and Anti-Kickback Statute.

The lawsuit was initially filed under the whistleblower provisions of the False Claims Act by Dr. Christian Heesch, a physician formerly employed by DPG. The United States later intervened in the case in connection to some of Dr. Heesch’s allegations. Dr. Heesch will receive a $4.41 million share of the settlement.

According to the government’s complaint, IMC-Diagnostic and Medical Clinic, in Mobile, Alabama, and IMC-Northside Clinic, in Saraland, Alabama, had agreements with DPG to pay the group a percentage of Medicare payments for tests and procedures referred by DPG physicians. Infirmary Medical Clinics P.C. (IMC), an affiliate of IHS that directly owns and operates about 30 clinics in the Mobile area, including the two clinics involved in this matter, was also named in the lawsuit.

In addition, the suit contends that when IMC purchased IMC-Diagnostic and Medical Clinic from DPG in 1988, it supposedly agreed to pay DPG a share of the revenues brought in by the clinics, including Medicare payments for diagnostic imaging and laboratory tests.

When IMC acquired the IMC-Northside Clinic in 2008, the physicians there joined DPG and allegedly entered into an agreement that was similar to the earlier agreement with IMC-Diagnostic and Medical Clinic.  These payments are considered illegal kickbacks, and constituted a prohibited financial relationship under the Stark Law, the lawsuit argued.

In June 2010, an attorney for DPG pointed out to IMC and DPG employees that there was a probable violation of the law and warned them that the compensation being paid to the physicians was likely illegal. However, the financial agreements supposedly continued for another 18 months before being modified or terminated.

U.S. Attorney Kenyen Brown for the Southern District of Alabama said the “settlement represents a single but significant step towards achieving integrity in the administration of public health programs in this region.”

“Physicians, physician groups and other medical entities operating illegally within public health programs will be held accountable.  I also commend whistleblowers like Dr. Christian Heesch, who helped bring this particular case to light,” he added.

As part of the settlement, the defendants have consented to a Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). This requires the defendants to undertake substantial internal compliance reforms and to submit its federal health care program claims to independent review for the next five years.

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees who have knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect up to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss your case.