Illegal Kickback Scheme Alleged in Florida Hospital FCA Suit

A whistleblower has accused Naples Community Hospital Inc. in Florida of putting together an illegal kickback scheme in which physicians who gave patient referrals led to many millions of fraudulently obtained funds from Medicaid and Medicare.

Did you know that someone who witnesses illegal activity and takes action by reporting this to the authorities might not only stop the behavior and save taxpayer dollars, but he or she could also be protected under whistleblower laws at the federal level?

What Is an Illegal Kickback Scheme in Terms of Healthcare Fraud?

An illegal kickback scheme can take many forms, but the primary idea behind it is that doctors or healthcare entities involved in Medicaid or Medicare fraud are attempting to encourage referrals from one organization to another in order to ramp up the number of cases with federal healthcare claims. Healthcare fraud in an illegal kickback scheme can take many forms, such as giving services to patients who don’t need them or alleging that services never performed were given to a patient on the billing paperwork.

Claims Lodged in New Illegal Kickback Scheme Suit

According to the illegal kickback scheme lawsuit, a Florida radiologist over-payed cardiologists in an effort to illegally refer patients, including those who receive Medicare benefits, to NCH hospitals and clinics throughout the state.

According to the whistleblower who reported this illegal kickback scheme, the cardiologists associated with NCH have generated losses in greater than $60 million over the past 5 years, but revenue that is received by the referrals from doctors that are monitored and tracked by NCH executives helps to offset the losses. The strategy allegedly initiated in the illegal kickback scheme in September of 2010. The radiologist who came forward as a whistleblower shared that the scheme violates federal anti-kickback laws and alleges false billing claims have deprived Medicaid and Medicare of taxpayer dollars.

The hospital group encouraged cardiologists to become employed with them using inflated salary offers and then demanded that they generate more referrals if the revenues received from those referrals did not help to offset the higher salaries, says the complaint. According to the whistleblower, this was portrayed as “charitable health care” by the company.

The radiologist who reported the illegal kickback scheme says in the complaint that the United States is entitled to treble damages under the False Claims Act, as well as civil penalties charged between $5,500 and $11,000 for each violation.

The False Claims Act is in place to help catch people engaged in government fraud. Under the law, those who report the fraud, including employees and other whistleblowers, have recourse and protection from retaliation. Anyone who brings forward an FCA claim may need legal help to determine their next steps and to figure out what’s in their best interest going forward.

The Illegal Kickback Scheme Lawsuit is U.S. ex rel. Eric Vensel M.D. v. Naples Community Hospital Inc. et al., Case No. 2:16-cv-00189, in the U.S. District Court for the Middle District of Florida.

Do you believe you have evidence of an illegal kickback scheme? Schedule a consultation today with the lawyers at Bradley/Grombacher.

Bradley/Grombacher is not representing the plaintiff in this lawsuit.