According to the ruling of the 11th U.S. Circuit Court of Appeals, a former health care executive that exposed a kickback and illegal referral scheme by his employer will be allowed to proceed with certain allegations listed in his False Claims Act lawsuit against his ex-employer.
J. Michael Mastej, the whistleblower in this case, alleges that his former employer, Health Management Associates, Inc., violated the Stark Law and paid out kickbacks during his employment with the company. Mastej was an executive with the organization from 2007 to early 2007, and became intimately familiar with the various operational aspects associated with the alleged fraud.
He filed his qui tam complaint alleging that the organization violated the Stark Law and the anti-kickback statute by making illegal payments to six different neurosurgeons and offering all-expenses-paid golf trips to four other doctors on Health Management’s private jet with the hopes of them referring Medicare patients to the company’s facilities.
The anti-kickback statute prohibits health care facilities from financially coercing people to make Medicare referrals to patients. The Stark Law also prohibits these types of referrals, focusing on preventing doctors from referring Medicare patients to a specific hospital if the doctor has a certain “financial relationship” with the hospital in question. The Stark Law also prohibits those same hospitals from sending payment claims to Medicare for services rendered to referred patients.
The alleged kickbacks in this case were extra “on-call” payments of $1,000 on weekdays and $2,000 on weekends. According to Mastej, the on-call coverage payments were unnecessary because all neurosurgeries were planned ahead of time and there were no emergency procedures performed by neurosurgeons at the hospital.
If you become aware of fraud within a health care organization, it’s important that you speak out right away. Meet with the experienced attorneys at Whistleblower Law for Managers in Dallas to secure strong legal representation as you alert the proper authorities to the fraud.