February 22, 2022
The U.S. Attorney’s Office for the District of New Hampshire announced the settlement of an improper kickback case involving Catholic Medical Center (CMC). The New Hampshire hospital will pay $3.8 million to resolve allegations of improper kickbacks in violation of the Anti-Kickback Statute. CMC allegedly provided free cardiologist coverage to a cardiologist in return for the referral of cardiac patients to the hospital.
The kickback allegations first came to light when former CMC employee, David Goldberg, M.D., filed a qui tam lawsuit under the False Claims Act. The whistleblower alleged that cardiologist, Dr. Mary-Claire Paicopolis, referred patients to CMC in return for CMC providing its employee cardiologists to cover for Dr. Paicopolis after-hours, on weekends, and on holidays. The complaint asserts payments made to CMC’s employees willing to participate in the scheme were well above market rate.
The whistleblower also alleged a second prong to the scheme: the provision of unnecessary medical services. Dr. Paicopolis allegedly referred patients to CMC for unnecessary cardiology services. The examples listed in the complaint include a patient who suffered renal failure after receiving an unnecessary implantable cardiac defibrillator. A second patient died after an allegedly unnecessary cardiac catheterization. Performing unnecessary procedures permitted CMC to maintain a high procedure volume at the expense of federal healthcare programs and with total disregard for patient safety.
Services of value provided for referrals of government healthcare beneficiaries are improper kickbacks in violation of the Anti-Kickback Statute (AKS). Each bill submitted for medical services tainted by an improper kickback-for-referral scheme is a false claim. The False Claims Act provides for monetary penalties of between $11,803 to $23,607 for each false claim submitted. In addition to civil penalties, violations of the AKS can also carry criminal penalties as we discussed in our previous post involving improper referrals for home health care.
These penalties discourage fraud so patients receive the most appropriate care from the most appropriate clinician, rather than from whomever is willing to pay the biggest kickback. When the tenuous resources of Medicare, Medicaid, TRICARE and other government programs are used to pay claims tainted by improper conduct, there are fewer resources available for meritorious care.
The Whistleblower Law Collaborative LLC devotes its practice entirely to representing clients nationwide in bringing actions under the federal and state False Claims Acts and other whistleblower programs. Under the False Claims Act, a private citizen (known as a “relator”) who suspects or knows of fraud against the government can act as a whistleblower and file a sealed complaint on behalf of the government. If the case is successful, the relator is entitled to a share of the government’s recovery. Among the firm’s many successes is the governments’ $885 million settlement with AmerisourceBergen.
For more information, contact the Whistleblower Law Collaborative LLC at 617.366.2800.