Intermountain Health Care Inc., a major health system in Utah, has agreed to a $25.5 million settlement with the United States Department of Justice. This settlement resolves allegations that Intermountain violated the Stark Statute and the False Claims Act through improper financial arrangements with doctors who referred patients to their facilities. The announcement was made by the Justice Department, highlighting the government’s ongoing efforts to combat healthcare fraud and ensure fair practices within the medical industry.
The core of the issue revolved around financial relationships between Intermountain and referring physicians. According to the Justice Department, these relationships breached the Stark Statute, which is designed to prevent conflicts of interest in patient referrals. The alleged violations included employment contracts where physician bonuses were improperly calculated, taking into account the value of their patient referrals. Furthermore, concerns were raised about office leases and compensation agreements between Intermountain and referring physicians that did not meet the Stark Statute’s requirements. It is important to note that Intermountain Health Care voluntarily disclosed these issues to the government, which is often seen as a sign of corporate responsibility and cooperation.
Stuart F. Delery, Acting Assistant Attorney General for the Department’s Civil Division, emphasized the importance of this settlement, stating, “The Department of Justice is deeply concerned about inappropriate financial links between healthcare providers and those who refer patients. These kinds of relationships can undermine a physician’s objectivity when deciding what healthcare a patient truly needs.” Delery further added that the settlement not only recovers funds for taxpayers but also serves as a deterrent against similar misconduct, ultimately aiming to make healthcare more affordable for patients.
Echoing this sentiment, Gerald Roy, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services, praised Intermountain for their self-disclosure. “Patients deserve to trust that decisions made by hospitals and doctors are based on their health needs, not financial incentives,” Roy stated. He affirmed the commitment to protecting taxpayer-funded health programs from Stark violations through collaboration with the Department of Justice.
This settlement is part of the government’s broader initiative against healthcare fraud, particularly through the Health Care Fraud Prevention and Enforcement Action Team (HEAT). Launched in 2009, HEAT aims to reduce Medicare and Medicaid fraud through enhanced cooperation between the Department of Justice and the Department of Health and Human Services. The False Claims Act is a critical tool in these efforts, enabling the recovery of over $10.2 billion in cases of fraud against federal health care programs since January 2009, and over $14.2 billion in total False Claims Act recoveries during the same period.
The case was jointly handled by several government bodies, including the Justice Department’s Civil Division, the U.S. Attorney’s Office for the District of Utah, the Office of Inspector General of the Department of Health and Human Services, and the Centers for Medicare and Medicaid Services. It is crucial to remember that the claims resolved by this settlement are allegations, and there has been no formal determination of liability against Intermountain Health Care. However, this case underscores the rigorous scrutiny of financial arrangements within the healthcare sector and the government’s dedication to enforcing regulations like the Stark Statute and the False Claims Act to protect both patients and taxpayer funds.
