A Massachusetts hospital has agreed to pay to the Federal government $26.67 million to settle claims that it improperly billed government programs for illegally-obtained referrals and testing equipment that was not eligible for reimbursement because the testing was a product of paid-for referrals.
Per prosecutors, the Boston hospital conspired with several other parties to obtain referrals by way of doctors to whom they paid kickbacks disguised as investment returns. They say the hospital established management service organizations that funneled the kickbacks to doctors with the help of independent marketers.
They say the hospital identified doctors it believed would participate in the program, referred them to the management service organizations, and cooperated with the management service organizations in developing effective pitches aimed at doctors and designed to obtain more referrals.
In addition, investigators say the hospital agreed to provide laboratory testing services to small hospitals in Texas in exchange for per-test payments. Physicians participating in the hospital’s kickback scheme allegedly referred patients to those hospitals in Texas for their laboratory tests. In turn, the Boston hospital billed Medicare, Medicaid, and TRICARE for the tests that it obtained via illegal kickbacks.
Charges in the case were brought by an individual under the qui tam, or “whistleblower” provision of the False Claims Act (a/k/a, “Lincoln’s Law”), which allows whistleblowers to begin a suit against the firm and hand it over to Federal prosecutors if they find the suit to have merit.