Atlanta Gastroenterology Associates accused of receiving kickbacks for pathology referrals and performing medically unnecessary gastrointestinal testing services.
Atlanta Gastroenterology Associates 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 medically unnecessary gastrointestinal pathology services.
The US Department of Justice alleged that, beginning in May 2017, the Atlanta-based practice contracted with Advanced Pathology Solutions (APS), a pathology laboratory in Little Rock, Arkansas, to construct and operate a limited-capacity pathology laboratory within Atlanta Gastroenterology Associates’ office.
Under the arrangement, Atlanta Gastroenterology Associates received various benefits from APS in connection with the setup and ongoing operations of the in-house lab, where histology technicians prepared and stained specimen sample slides. The gastroenterology practice billed Medicare and other insurers for the technical component of those services while exclusively referring patients to APS, which interpreted the slides and billed for the professional component.
“Healthcare fraud has negative impacts for taxpayers and patients alike,” says assistant attorney general Brett A. Shumate of the Justice Department’s Civil Division, in a release. “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.”
Allegations of Unnecessary Special Stains
The government also alleged that Atlanta Gastroenterology Associates performed and billed for medically unnecessary special stains using a blanket or reflex ordering process. Under this process, special stains were ordered automatically 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.
“Federal health care programs rely on truthful billing and accurate medical documentation,” says special agent in charge Jason E. Meadows of the US Department of Health and Human Services Office of Inspector General Dallas Regional Office, in a release. “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.”
Atlanta Gastroenterology Associates and APS terminated their relationship in May 2020.
Multi-Agency Investigation
The resolution resulted from a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, and the US Attorney’s Office for the Eastern District of Arkansas. The investigation received 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 claims resolved by the settlement are allegations only, and there has been no determination of liability.
ID 35293637 © Sergii Gnatiuk | Dreamstime.com
