TL/DR –
An ophthalmology practice in West Central Florida has paid approximately $1.3 million to settle kickback allegations related to billing for unnecessary transcranial doppler ultrasounds (TCDs). The illegal financial relationship reportedly involved a contractual arrangement between the practice and a third-party vendor of TCD services; the practice allegedly submitted false claims to the Medicare and Medicaid programs for TCDs based on false diagnoses. The case underscores the U.S. government’s focus on unlawful financial arrangements in the health sector in Florida, regardless of the amount of remuneration involved.
Florida Ophthalmology Practice Settles Kickback Allegations
The U.S. Department of Justice (DOJ) revealed on Nov. 12, 2024, that a Florida-based ophthalmology practice (the Provider) agreed to a $1.3 million settlement over alleged kickbacks involving billing for transcranial doppler ultrasounds (TCDs). The settlement spotlights the government’s commitment to tackling unlawful healthcare financial dealings in Florida.
Illegal Financial Relationship
The DOJ’s press release suggests a contractual agreement between the Provider and a third-party mobile TCD services vendor (the Third-Party Provider). This contract allowed the Provider to identify patients for Medicare or Medicaid TCD reimbursement based on a serious diagnosis, before receiving the TCD result. Most patients, however, did not have the diagnosis, causing discrepancies in medical history and TCD results. For each TCD procedure ordered for a Medicare patient, the Provider submitted reimbursement claims, paid the Third-Party Provider based on the volume or value of ordered procedures, and referred the patient to their preferred radiology provider.
Alleged Violations
As a result of this, the DOJ claims the Provider submitted false claims to the Medicare and Medicaid programs for unnecessary TCDs. The Provider allegedly violated the Anti-Kickback Statute and the Stark Law, leading to a majority of the settlement amount going to the U.S., with a small fraction to Florida’s Medicaid program.
Enforcement of Federal and Florida Laws
The illegal activities are associated with violations of the federal False Claims Act (FCA) and an analogous Florida statute. The government utilizes federal FCA to monitor violations of both Stark Law and Anti-Kickback Statute. Violations may result in treble monetary damages and other penalties. Florida has similar laws.
Implicated Laws
The federal Stark Law and Anti-Kickback Statute guard against incentivizing financial arrangements that compromise patients’ best interests. The government frequently uses the federal FCA to investigate violations of both laws, which could be instigated by whistleblowers and result in triple monetary damages. The state of Florida has analogous laws.
Violations and Penalties
Violations of federal and state laws can lead to hefty penalties, including fines, criminal liability, and exclusion from state or federal healthcare programs. There are exceptions and safe harbors offered under these laws to help providers maintain compliance. Healthcare counsel is crucial in structuring compliant financial arrangements in Florida’s healthcare sector.
Involvement of Legal Counsel
U.S. Attorney for the Middle District of Florida, Roger Handberg, stated that actions against providers exploiting federal health care programs for personal gains will continue. Legal firms like Holland & Knight offer assistance in reviewing existing financial arrangements and structuring new arrangements in compliance with fraud and abuse laws. Reach them at their Healthcare Regulatory Compliance or Healthcare Transactions teams.
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