Maryland provider to pay $22M to settle kickback, stenting issues
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First, the payments will help settle the allegations under the False Claims Act, which alleged that SJMC made unlawful payments under the Anti-Kickback Act and violated the Stark Law when it entered a series of professional services contracts with the MidAtlantic Cardiovascular Associates back in 2009. In addition, the money will resolve the whistleblower suit that accused former employee, Mark Midei, MD, a cardiologist, of performing hundreds of unnecessary stenting procedures.
Allegedly, SJMC paid kickbacks to MidAtlantic Cardiovascular Associates to gain referrals for profitable cardiovascular procedures, such as cardiac surgery, that took place between Jan. 1, 1996, and Jan. 1, 2006, according to the Department of Justice (DoJ).
Additionally, the payment will settle issues surrounding 11 professional service agreements between MidAtlantic and SJMC where MidAtlantic allegedly received payments that were above market value for services not rendered or that were unreasonable, but were entered to gain referrals from the practice for the hospital.
The DoJ said that SJMC has signed a corporate integrity agreement (CIA) with the Department of Health and Human Services, Office of Inspector General (HHS-OIG), that will require the facility to engage in activities to ensure accurate billing and relationships with its referral sources.
Additionally, the agreement mandates the appointment of a physician executive who will oversee staff quality-of-care issues and hire a peer review consultant who will evaluate SJMC’s peer review practice.
Lastly, an independent review organization will review all cardiac cath procedures performed at SJMC. The DoJ said that the hospital may be excluded from federal healthcare programs—Medicare and Medicaid—if noncompliance with the CIA agreement occurs and could also be subject to penalties.