Becker's has reported on five multimillion-dollar Stark law penalties in 2024:
1. A Denton, Texas-based medical center paid $14.2 million to settle alleged violations of Stark law and Medicare regulations related to four ASCs in the Dallas-Fort Worth area, specifically in Dallas, Richardson and Coppell.
Horizon Medical Center, which operates a long-term acute care hospital with several ASCs, self-reported that it failed to include a modifier and location to identify services performed at non-excepted, off-campus outpatient facilities when submitting claims to Medicare, according to a Nov. 4 news release from the Justice Department.
Horizon disclosed that it had entered into management agreements with third-party companies affiliated with physicians performing surgery at its outpatient facilities. It also leased equipment through operating agreements with companies affiliated with those same physicians.
2. Siouxland Surgery Center, doing business as Dakota Dunes, S.D.-based Dunes Surgical Hospital, United Surgical Partners International and USP Siouxland, agreed to pay about $12.76 million to resolve Stark law and False Claims Act allegations.
From at least 2014 through 2019, Dunes Surgical Hospital made large financial contributions to a nonprofit affiliate of a physician group that made patient referrals to Dunes Surgical Hospital. The agreement also resolves allegations that during the same period, Dunes Surgical Hospital provided a different physician group with free or below market value clinic space, staff and supplies.
3. A cardiac imaging company and its CEO agreed in April to pay more than $85 million to resolve False Claims Act allegations. Cardiac Imaging, based in Oakbrook Terrace, Ill., and its founder and CEO, Sam Kancherlapalli, were accused of paying referring cardiologists excessive fees to supervise PET scans. The lawsuit alleged this violated the Anti-Kickback Statute and Stark law.
4. In May, Pittsburgh-based UPMC agreed to pay $38 million to settle a whistleblower lawsuit alleging neurosurgeons employed by the health system submitted false claims. The suit was filed against the health system and 13 staff neurosurgeons in 2012 by former UPMC neurosurgeon William Bookwalter, MD, neurophysiologist Robert Sclabassi, MD, PhD, and surgical technologist Anna Mitina.
The suit alleged some neurosurgeons submitted claims for purportedly assisting with procedures performed by other surgeons or residents, even though they did not assist nor supervise. Additionally, one neurosurgeon allegedly submitted fraudulent claims to Medicare for levels of spinal decompression not performed. The allegations also resolved claims neurosurgeons were paid excessive compensation and surgeons referred procedures and surgeries to UPMC in violation of Stark law.
5. In March, NewYork-Presbyterian/Brooklyn Medical Methodist Hospital in New York City agreed to pay $17.3 million to resolve allegations that it paid unlawful kickbacks to physicians.
The hospital allegedly made payments to physicians at the hospital's chemotherapy infusion center, where physician compensation was linked to the number of referrals made for services at the center, according to a March 12 news release from the Justice Department.