Atlanta Gastroenterology Associates located in Atlanta, Georgia, has agreed to pay $4.75 million to resolve allegations that it violated the False Claims Act by receiving kickbacks in exchange for referrals of gastrointestinal pathology services and by performing certain gastrointestinal pathology services that were not medically reasonable or necessary.
The United States alleged that beginning in approximately May 2017, Atlanta Gastroenterology Associates contracted with Advanced Pathology Solutions (APS), a pathology laboratory located in Little Rock, Arkansas, to construct and operate a limited-capacity pathology laboratory in Atlanta Gastroenterology Associates’ office. Atlanta Gastroenterology Associates received various benefits from APS in connection with the setup and ongoing operations of the in-house lab, in which histology technicians prepared and stained specimen sample slides and Atlanta Gastroenterology Associates billed Medicare and other insurers for the technical component of those services. In exchange, Atlanta Gastroenterology Associates agreed to exclusively refer patients to APS, which interpreted the slides and billed for the professional component of the services. The United States alleges that the benefits provided by APS to Atlanta Gastroenterology Associates were unlawful remuneration in exchange for patient referrals.
“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 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 and also to seek the recovery of tax dollars that were wrongfully paid.”
“Federal health care programs rely on truthful billing and accurate medical documentation,” said Special Agent in Charge Jason E. Meadows of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Dallas Regional Office. “This False Claims Act settlement underscores our commitment to safeguarding taxpayer dollars and maintaining public trust by holding providers accountable when they fail to meet those obligations. 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.”
Additionally, the United States alleges that Atlanta Gastroenterology Associates performed and billed for medically unnecessary special stains using a blanket or reflex ordering process in which special stains were ordered on an automatic basis, without a pathologist first reviewing a routine stain and determining whether additional special stains were needed for the particular patient, and without justification in the medical record for performing additional special stains. Atlanta Gastroenterology Associates and APS terminated their relationship in approximately May 2020.
The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, and the United States Attorney’s Office for the Eastern District of Arkansas, with assistance from the Department of Health and Human Services, Office of Inspector General, the Department of Defense, Office of Inspector General, and the Department of Veterans Affairs, Office of Inspector General.
The investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
The matter was investigated by Trial Attorneys Evan Ballan and Jessica Bergin and Assistant U.S. Attorney Jamie Dempsey for the Eastern District of Arkansas.
The claims resolved by the settlement are allegations only and there has been no determination of liability.