A whistleblower who sued Sightline Health LLC, a Texas-based chain of radiation therapy centers, alleging the company assembled and operated an illegal kickback scheme has helped the U.S. government recover about $11.5 million.
The U.S. Department of Justice (DOJ) announced it reached an agreement with SightLine and Integrated Oncology Network Holdings LLC, which acquired SightLine in 2011, to settle the whistleblower’s allegations that SightLine was engaging in an improper kickback scheme designed to boost its Medicare reimbursements.
The whistleblower sued SightLine on behalf of the U.S. government under the False Claims Act. The DOJ investigated the whistleblower’s claims and chose to intervene, or actively litigate, the case.
The complaint alleged that SightLine violated the Anti-Kickback Statute and the False Claims Act by targeting physicians who could refer patients to SightLine’s cancer treatment centers. SightLine compensated the referring physicians with profitable investment arrangements.
According to the DOJ, SightLine structured the kickback scheme by forming a series of leasing companies in which the referring physicians were allowed to invest. SightLine then distributed profits from the referrals to the physician-investors in the form of dividends from the investments, which were essentially kickbacks for referring cancer patients to SightLine.
The Anti-Kickback Statute is intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and instead is based on the best interests of the patient. It prohibits anyone from offering, paying, soliciting, or receiving compensation for referrals of services or items covered by Medicare, Medicaid, and other federally funded programs.
“Companies seeking to boost profits by paying physicians kickbacks for patient referrals undermine impartial medical judgment and increase health care costs for everyone,” said Chief Counsel to the Health and Human Services Inspector General Gregory Demske. “We will continue to investigate such illegal, wasteful business arrangements in order to protect government health programs and the patients served by them.”
Whistleblowers whose False Claims Act lawsuits result in a recovery for the U.S. government receive an award of 15-25 percent of the total recovery, or up to 30 percent if the DOJ declines to intervene in a case. The whistleblower who sued SightLine will receive an award of about $1.72 million.