Lester E. Cox Medical Centers, a not-for-profit healthcare system headquartered in Springfield, Mo., has agreed to pay $60 million to settle claims that it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute between 1996 and 2005.
Cox Medical Centers "entered into certain financial relationships" with referring doctors at a local physician group and "engaged in improper billing practices with respect to Medicare," according to the Department of Justice.
"The Justice Department is committed to ensuring that the best interests of federal healthcare program patients are not compromised by unlawful payments to physicians," said Gregory G. Katsas, Assistant Attorney General for the Justice Department's Civil Division. "The resolution of this matter resulted in a significant recovery for taxpayers, and it exemplifies our dedication to vigorous enforcement of the Stark and Anti-Kickback Statutes."
Under the Stark Statute, Medicare providers are prohibited from billing the federal healthcare program for referrals from doctors with whom the providers have a financial relationship, unless that relationship falls within certain exceptions.
U.S. legal officials have contended that certain relationships between Cox and physicians ran "afoul" of the Anti-Kickback Statute, which prohibits offering inducements to providers in return for patient referrals, as well as the Stark statute.
Additional claims being resolved concern Cox's inclusion of non-reimbursable costs on its Medicare cost reports and improper billings for services provided to dialysis patients.
Cox officials have also signed a corporate integrity agreement with the U.S. Department of Health and Human Services Office of Inspector General which contains measures to ensure compliance with Medicare regulations and policies in the future.
"Today's settlement furthers both our commitment to protecting patients from improper billing practices and the continued ability of Cox to provide quality medical care in Springfield and the Ozarks," said John F. Wood, U.S. Attorney in Kansas City, Mo. "I am pleased that we were able to resolve this matter without litigation."