Dive Brief:
·
Sutter Health has agreed to pay $30 million to settle claims the
system violated anti-kickback laws by paying a group of cardiovascular surgeons
for referring patients to Sutter between 2012 and 2014, the Department of
Justice said Friday. (The DOJ
noted these are allegations only with no determination of liability).
·
Separately, Sutter agreed to pay an additional $15 million to
resolve allegations related to other conduct it self-reported to authorities,
which included violating anti-kickback laws and overbilling Medicare for
services performed at some of its surgery centers.
·
In the latest case, the allegations were brought to light in a
whistleblower lawsuit filed in 2014 by an employee who served as a compliance
officer for Sutter Medical Center in Sacramento. So far this year, Sutter
has agreed to pay $75 million to settle various allegations of
overbilling and improper kickbacks to physicians.
Dive Insight:
The federal
kickback laws were designed to deter physicians from referring patients to
other services or places that would financially benefit them because of the
referral. In October alone, the DOJ's Civil Division said various
healthcare organizations agreed to pay nearly $63 million to settle
kickback claims.
At the same
time, federal regulators want to relax the
nation's anti-kickback laws in an effort to remove barriers they say inhibit
innovative payment and care arrangements as the industry moves toward
value-based payment arrangements. In October, HHS unveiled proposals that
would usher in sweeping change to the anti-kickback statute and the Stark
Law.
In the Sutter
case, whistleblower Laurie Hanvey alleged Sutter agreed to financial
arrangements with physicians to incentivize them to refer patients to Sutter.
The arrangements allegedly included kickbacks, excessive compensation and
Sutter-paid staff, according to Hanvey's original complaint filed
in the federal court in the Northern District of California.
Hanvey will
receive nearly $6 million for her role.
In the original
complaint, Hanvey alleged Sutter provided physician assistants to
Sacramento Cardiovascular Surgeons Medical Group for the purpose of encouraging
referrals to Sutter for inpatient and outpatient services. Sutter allegedly
paid $680,000 annually for four physician assistants.
The group,
known as Sac Cardio, has agreed to pay $506,000 to resolve claims related to
duplicative bills sent to Medicare for these physician assistants.
In April,
Sutter agreed to pay $30
million to settle claims it received overpayments from the Medicare Advantage
program. Sutter was accused of inflating the risk scores of some MA
beneficiaries to receive higher capitated payments.
"Improper
financial arrangements between hospitals and physicians can influence the type
and amount of health care that is provided,” Assistant Attorney General
Jody Hunt of DOJ's Civil Division said in a
statement.
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