The United States Department of Justice (DOJ) alleged that a New Hampshire-based hospital, Catholic Medical Center (CMC), paid its own cardiologists to serve as free on-call substitute doctors when one particular cardiologist was on vacation or otherwise unavailable. (LINK to DOJ Press Release on Hospital Settling False Claims Allegations). In exchange, the cardiologist who received free on-call substitute services referred millions of dollars in medical procedures and services to CMC. (LINK to Story on CMC False Claims Settlement). CMC then billed some of the referral services to federal insurance programs, such as Medicare and Medicaid, which the DOJ believed violated federal anti-kickback laws.
A former CMC doctor turned whistleblower obtained legal representation, and brought these violations to light under the False Claims Act’s whistleblower provisions. (LINK to Story on Three February Whistleblower Settlements). CMC settled with the DOJ for $3.8 million, and the whistleblower will be eligible to receive between 15% and 30% of those settlement funds. Lawyers and and other legal experts nationwide continue to see swift action by the DOJ in an ongoing effort to combat Medicare and Medicaid fraud, often resulting in large settlements. FBI Agent Joseph R. Bonavolonta stated, “Kickback schemes can undermine our healthcare system, compromise medical decisions, and waste taxpayer dollars.”