New York Health Care Law Blog

A diagnostic laboratory recently agreed to pay the government almost $12 million to settle claims that the health care company violated federal Anti-Kickback Statute (AKS) regulations. The government claimed that individuals within the diagnostic lab were illegally bribing health care professionals to use the professional services offered within their lab.

The investigation began after a former employee moved forward with a qui tam lawsuit. If successful, these cases, also known as whistleblower cases, result in financial gain for the individual that begins the case. In this situation, the whistleblower that brought the case forward will likely receive approximately 20% of the settlement.

The United States Centers for Medicare and Medicaid Services (CMS) has rolled back some regulatory provisions in response to the current coronavirus pandemic. Officials reason that these rollbacks will help to better ensure patients can get the testing, diagnosis and treatment needed during these uncertain times.

A recent healthcare fraud case out of New York, New Jersey and Pennsylvania involves two physicians and multiple other individuals who allegedly used illegal kickback payments to conduct and bill Medicare for unnecessary genetic testing. The government claims to have multiple pieces of evidence to support the claims, including:

The United States Department of Justice (DOJ) and the Office of the Inspector General (OIG) have stated they will aggressively pursue health care fraud claims related to COVID-19. These agencies further clarify that they will continue to focus on prosecution for violations of the Eliminating Kickbacks in Recovery Act (EKRA). The announcement comes at an uncertain time, when diagnostic labs are working to help patients who are waiting for testing while living amidst a global pandemic.