Medicare Compliance & Reimbursement

Don't rely overly on the employment exception -- or discount a competitor's ability to stir up trouble. Covenant Medical Center in Waterloo, Iowa, recently agreed to fork over a hefty $4.5 million to settle a federal False Claims Act lawsuit involving alleged Stark law violations. The case provides a potential harbinger of things to come and some "lessons learned" for hospitals and physicians trying to survive a growing government crackdown on fraud and abuse. The crux: The U.S. government claimed that Covenant submitted false claims to Medicare because it had gravely overpaid five employed physicians who referred patients to the hospital for services -- a verboten practice under the physician self-referral Stark law. In a news release announcing the settlement agreement, the Department of Justice noted that the Covenant physicians ranked among the best paid hospital-employed physicians not only in Iowa, but nationwide. As for the physicians' fate: The DOJ doesn't anticipate [...]