After the United States decided to intervene, a whistleblower lawsuit under the federal false claims act was unsealed. The Amended Complaint alleges that over the period 2004 to 2010, the defendants submitted over $500 million in claims to Medicare, Tricare, and Medicaid that were the result of physician compensation schemes in violation of Stark and Anti-Kickback laws.
According to the Amended Complaint, a seventy-one (71) member physician group provided outpatient care and treatment for clinic patients under a services contract with the clinic. Under the contract, the clinic billed and collected for the physician services and split the net proceeds with the physician group.
The Amended Complaint alleges that the physician group received two additional components of compensation intended to induce referrals to the clinic and increase the tests ordered at the clinic. According to the Amended Complaint, the clinic furnished the physician group with office space, equipment, and a variety of services at below fair market value. In addition the physicians in the group were allegedly paid a percentage of the technical fees charged and collected by the clinic for tests they ordered.
The whistleblower is an interventional cardiologist who was employed by the physician group from 2003 until he was fired in 2011.