Credit: Jeff Cohen
Backlink to: https://www.justice.gov/usao-edca/pr/fresno-doctors-agree-pay-24-million-resolve-kickback-allegations
Two California doctors recently found themselves in hot water over an βarrangementβ with mail-order pharmacies that resulted in $2.4 million in settlements. Hereβs what happenedβand why healthcare professionals and businesses should take notice.
The doctors invested in management services organizations (MSOs) with financial returns labeled as βinvestment returns.β While these seemed to resemble βrealβ investments, the U.S. Attorneyβs investigation pointed to a troubling connectionβthe higher the scripts sent to the pharmacies, the more financial returns the doctors received.
Key takeaways from the case:
- Alarming Pattern: Investments βpaid offβ multiple times the original capital, and prescribing physicians were offered new opportunities to invest in profit-making MSOs.
- Kickback Red Flags: One representative stated, βIf he doesnβt write, he canβt have shares,β highlighting the clear linkage between prescribing volume and financial rewards.
- Critical Compliance Reminder: Regardless of appearances, no investment or arrangement can involve referral-based incentives, particularly when state or federally funded healthcare programs (like TriCare, Medicare, or Medi-Cal) are involved.
For Healthcare Professionals
Never exchange anything of valueβwhether direct payments, investment returns, or other financial incentivesβfor referrals or orders. Even arrangements that appear to comply with βsafe harborβ rules can come under intense scrutiny if thereβs a financial link to prescribing behavior.
This case serves as a stark reminder that healthcare compliance goes beyond legal advice or documentationβit requires ensuring every action prioritizes ethical care and keeps patient trust intact.
Have questions about maintaining compliance? Share your thoughts below or connect with me for a deeper conversation.