The OIG for the Department of Health and Human Services entered into a Civil Monetary Penalty (CMP) settlement agreement for $7.3 million with United Shockwave Services, United Prostate Centers, and United Urology Centers (collectively, United), all of which are based in the Chicago, Illinois area.
This agreement settles charges by OIG alleging that United, and certain of its physician-owners, leveraged patient referrals to obtain contract business from hospitals in Illinois, Indiana, and Iowa, therefore violating Federal anti-kickback laws. OIG also alleged that United caused certain hospitals to submit claims for designated health services that resulted from prohibited referrals in violation of the Physician Self-Referral Law (Stark law).
Along with the $7.3 million settlement, United entered into a 5-year Corporate Integrity Agreement (CIA), which requires United to hire an Independent Review Organization that will monitor United and any hospital in Illinois, Indiana or Iowa that recieves referrals from United or its physician investors. Further, United is also required to create a comprehensive training program to educate its employees and corporate members on Stark law and kickback issues.
This settlement underscores the importance of taking proactive measures to have health care business relationships analyzed for compliance with the myriad of fraud abuse laws and regulations prior to the initiation of any government audit or investigation and to seek experienced, learned health care legal counsel upon receipt of any inquiry by the government or any third party payor into business relationships to attempt to avoid the matter escalating into a civil or even criminal matter.
For questions or concerns regarding fraud and abuse matters, please contact Adrienne Dresevic, Esq., and for questions or concerns regarding government or third party payor investigations, please contact Robert S. Iwrey, Esq., of The Health Law Partners at (248) 996-8510.