Source: United States Attorneys General
Former hospital chief executive officer (CEO) Jeffrey Madison, of Georgetown, Texas, has agreed to pay $5,343,630 to resolve allegations under the False Claims Act involving illegal payments to physicians for laboratory referrals in violation of the Anti-Kickback Statute. Madison also has agreed to cooperate with the Justice Department’s investigations of, and litigation against, other participants in the alleged schemes.
“The Justice Department will continue to pursue individuals — including C-suite executives — who commit health care fraud,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Kickbacks to physicians from laboratories or other healthcare providers can undermine healthcare decision-making, subject patients to unnecessary medical services and waste taxpayer funds.”
The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded health care programs. The Anti-Kickback Statute is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives and are instead based on the best interests of their patients.
The settlement announced today resolves allegations in a lawsuit alleging that Madison, the former CEO of Little River Healthcare (Little River), a critical access hospital in Rockdale, Texas, caused the submission of false claims for laboratory testing to Medicare, Medicaid and TRICARE from January 2015 to June 2018. Madison allegedly agreed to a kickback scheme in which Little River paid commissions to recruiters who used purported management service organizations (MSOs) to pay kickbacks to doctors to induce their laboratory testing referrals to Little River. The settlement resolves allegations that Madison knowingly signed, and caused others to sign, false certifications in Medicare cost reports regarding Little River’s compliance with the Anti-Kickback Statute, and thereby caused the submission of false claims to federal health care programs.
In addition, the settlement resolves allegations in the same lawsuit that, after defendant Doyce Cartrett Jr., M.D., of Silsbee, Texas, informed Little River of his potential laboratory testing referral volume, Madison agreed to have Little River pay Cartrett $2,000 per month in kickbacks disguised as purported medical director fees from February 2015 to May 2017, to induce Cartrett to shift his laboratory testing referrals to Little River. Madison allegedly agreed for Little River to pay the monthly fees, even though Little River did not receive any genuine medical director services from Dr. Cartrett.
Madison did not contest, and accepted responsibility for, the allegations against him in the United States’ amended complaint. Under the terms of the settlement agreement, Madison was excluded from participating in federal healthcare programs for 25 years. The lawsuit is captioned United States, et al. ex rel. STF LLC v. True Health Diagnostics LLC et al., No. 4:16-cv-547 (EDTX).
“Seeing past a corporate entity and holding individuals responsible for making the decisions to engage marketers to pay providers for their laboratory referrals is what justice requires,” said U.S. Attorney Damien M. Diggs for the Eastern District of Texas. “This settlement is a testament to our continued efforts to combat fraud against our federal healthcare programs and to hold accountable all participants who profited from knowingly violating the laws meant to guard against overutilization of medical services and protect the public fisc.”
“Illegal kickback payments, even when disguised as medical director fees, undermine and corrupt the medical decision-making process,” said Special Agent in Charge Jason E. Meadows of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Both the payer and recipient benefit from these schemes, but it is ultimately the taxpayers who foot the bill. HHS-OIG will continue collaborating with law enforcement and prosecutors to protect the Medicare trust fund that millions of Americans depend on.”
“Our nation’s uniformed military service members and their families should never have to question the integrity of their healthcare providers,” said Acting Special Agent in Charge Ryan Settle of the Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Southwest Field Office. “Medical decisions influenced by greed destroy the fundamental element of trust in patient care. This settlement reinforces the commitment the DCIS shares with our law enforcement partners and the Justice Department to pursue all available remedies against those who conspire to commit fraud against our Military Health System.”
The settlement was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Eastern District of Texas, with assistance from HHS-OIG and DCIS. The United States has recovered over $52 million relating to conduct involving MSO kickbacks to health care providers, which includes recoveries from 46 physicians.
Trial Attorneys Christopher Terranova and Gavin Thole of the Civil Division’s Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorneys James Gillingham and Betty Young for the Eastern District of Texas handled the case.
The government’s pursuit of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to HHS at 1-800-HHS-TIPS (800-447-8477).