A CVS subsidiary recently struck a $60 million settlement to resolve kickback allegations, the latest settlement highlighting financial threats to Medicare programs.
Oak Street Health allegedly paid third-party insurance agents to recruit to its primary care clinics seniors who were either eligible for or enrolled in Medicare Advantage, regardless of the best interests of the seniors, in violation of the False Claims Act and Anti-Kickback Statute, according to a release. Some Medicare Advantage plans contract with health care providers like Oak Street Health to provide primary care services to plan members.
Fraud and kickbacks in the popular Medicare Advantage program, also known as Part C or managed care, pose a worrisome problem — not just because they misuse billions of taxpayer dollars to pad a private company’s bottom line; they also can affect the quality of care that the wrongfully documented patient receives in the future.
Medicare Advantage costs the government more per patient; there’s concern that unsupported diagnosis codes are being added to patients’ charts. In recent audits, the government’s Medicare watchdog organization found that 70 percent of the diagnosis codes weren’t supported by the patient’s medical record.
The nation depends on whistleblowers to help root out corruption in this area — and whistleblowers are eligible for an award of up to 30 percent of recoveries, which often include substantial penalties. Keller Grover’s Kate Scanlan recently helped a whistleblower pursue a case against Sutter Health for adding false medical conditions to Medicare Advantage patient records in order to get bigger payments from the government. The case resulted in a record $90 million settlement.
The False Claims Act targets fraud against the government; the Anti-Kickback Statute prohibits any sort of payment for patient referrals or recommendations related to items or services covered by federally funded programs.
If you suspect or have knowledge of fraud in Medicare Part C, or other fraud against the government, contact Keller Grover for a confidential, free consultation. We can advise potential whistleblowers about the best path forward from the very beginning, helping minimize the impact of reporting, protect rights and achieve the best possible outcome for the situation.