When your doctor makes a treating decision– whether it be a decision to implant a certain medical device, to prescribe a certain drug, or to refer you for other medical services–you want to be assured that your doctor is doing so for the right reasons. That is, you want to be assured that the doctor’s decision is unbiased and based solely on his or her professional opinion as to what is in the patient’s best interest.
All too often, however, the doctor’s decision making is tainted with prospect of monetary gain from pharmaceutical companies, medical device companies, and other third parties who stand to make millions of dollars based on the doctor’s decision to use their drug or product. The prospect of monetary gain comes in the form of bribes, kickbacks, or other material benefits that the drug or medical device companies or other third parties give or promise to give doctors in exchange for using their products or services. Such bribery often leads to doctors prescribing or using unnecessary or unduly expensive products and services, thus causing great waste. It also leads to patients getting exposed to dangerous products and procedures, putting their lives unnecessarily at risk.
The False Claims Act is a powerful tool in combating healthcare bribery and kickback schemes. Working in tandem with two federal statutes, the False Claims Act allows whistleblowers to bring their own actions to stop schemes that provide doctors with illegal financial incentives. The federal statutes are known as the Anti-Kickback Statute and the Stark Act.
The Stark Statute, 42 U.S.C. § 1395nn, forbids doctors from referring patients to certain health service providers in which the doctor has an interest. For example, many doctors have ownership or other financial interests in medical service providers, like, for example, an imaging center or a center that provides radiation therapy. In such cases, doctors are incentivized to refer patients for unnecessary and even dangerous medical services. The Stark Statute generally forbids a doctor from referring patients to the service provider in which he or she has a financial interest, and the service provider may not bill the government for such services.
If you have witnessed doctors paying for referrals, receiving anything of value from third parties who stand to gain from the doctors’ using their products, or referring patients to clinics or centers in which the doctor has a financial interest, you could have a viable whistleblower claim under the False Claims Act. There are, however, many “safe harbors” and other complicating factors under the statutes and regulations, so it is important that you get your case evaluated by a qualified whistleblower attorney.