ATLANTA - Atlanta Gastroenterology Associates has agreed to pay $4.75 million to resolve allegations that it accepted kickbacks for referrals and performed medically unnecessary pathology tests, the Justice Department announced Friday.
What we know:
The settlement addresses claims that the Atlanta-based practice violated the False Claims Act by entering into an unlawful arrangement with Advanced Pathology Solutions (APS), a laboratory in Little Rock, Arkansas. Federal investigators alleged that starting in May 2017, APS provided the practice with benefits to set up and run an in-house lab. In exchange, the practice exclusively referred patients to APS for professional slide interpretations.
In addition to the referral allegations, the government claimed the practice billed for "special stains" that were not medically necessary. These tests were allegedly ordered automatically through a "reflex" process before a pathologist could determine if they were actually needed for the patient.
The relationship between the practice and APS ended in May 2020. The settlement was the result of a coordinated effort between the Justice Department, the Department of Health and Human Services, the Department of Defense, and the Department of Veterans Affairs.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.
What they're saying:
"Healthcare fraud has negative impacts for taxpayers and patients alike," said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. "This settlement reflects the Department’s commitment to protecting taxpayer money and ensuring that healthcare services paid for by federal healthcare programs are reasonable, necessary, and free from the influence of kickbacks."
"As recent headlines across the country have made us all too aware, fraud against the American taxpayer through healthcare fraud is rampant," said U.S. Attorney Jonathan D. Ross for the Eastern District of Arkansas. "We will continue working with our law enforcement partners to identify and eliminate fraud of every kind wherever we find it."
Special Agent in Charge Jason E. Meadows of the HHS-OIG Dallas Regional Office noted that the settlement underscores a commitment to holding providers accountable.
"Providers who induce referrals by paying illegal kickbacks place an unfair burden on these programs, and we remain steadfast in working with our law enforcement partners to identify and address such conduct," Meadows said.
The Source: The details in this article come from the U.S. Attorney's Office.