The DOJ has filed a false claims act suit against the former general counsel for Tenet Healthcare, previously known as National Medical Enterprises, Inc. Just last week Thomas F. O’Neil III and Melinda H. Waterhouse
of DLA Piper LP posted an excellent summary of the case. <<http://lawfuel.com/show-release.asp?ID=16358>>
Tenet already has paid $920 million as a result of a qui tam whistleblower suit for Medicare fraud. In this suit, the DOJ is asking that the lawyer personally pay tens of millions of dollars.
An NME executive wrote a memo suggesting that NME’s contracts with doctors violated the Stark Act. The Stark Act is aimed at preventing kickbacks when patients are referred to a physician. The theory behind the Stark Act is that the kickbacks ultimately get passed along to the consumer, and thus to Medicare and Medicaid.
The suit claims that the general counsel hired an outside law firm, which issued a report saying NME’s contracts with the doctors did in fact violate the Stark Act. Nonetheless, it suggests, four days later the general counsel certified that NME was in compliance with the law, and she certified compliance again one year later. She did ask another employee to take the corrective measures that the outside firm had suggested, but, per the suit, apparently she never followed up.
I’ve been saying all along that healthcare professionals, billing department employees, nurses, etc., have got to protect themselves. In a corporate environment, it’s easy to buy into “group think” – the company makes all the decisions, you just do what you’re told to do. But this case certainly makes it clear how dangerous an assumption that is. Nobody in the healthcare field, regardless of whether they are giving direct medical care, should make that assumption. If you know about fraud, don’t put yourself in a spot to take the heat for it.
