New on the job at a health care company, a Fulton County woman came to believe that her employer was getting patient referrals by providing kickbacks to doctors and their staffs.
Now, that employer, Atlanta-based American Health Imaging, and its founder and former CEO, Scott W. Arant, have agreed to pay $5.25 million to settle allegations brought by Tanya Benjamin in a whistleblower lawsuit.
Benjamin brought the suit almost 10 years ago under the federal False Claims Act, which allows private parties to sue individuals or companies defrauding government programs and share in any funds recovered. The Department of Justice later intervened on some of the claims in her lawsuit, taking over the litigation. The Inspector General’s Office of the U.S. Department of Health and Human Services and lawyers from the Georgia Attorney General’s Office also took part in the investigation.
In announcing the settlement Monday, government prosecutors said that from 2011 to Sept. 15, 2019, the radiological company relied on a variety of inducements to get patient referrals. Among the financial incentives, the government said, were tickets to SEC games, fishing trips, meals, concert tickets, gas cards, alcohol, outings to nail salons and free scans for referring physicians and others.
What’s more, the company had agreements with physicians that paid them above-market rates to interpret the diagnostic scans of patients they had referred to the company.
Those amounted to illegal kickbacks, the government said, defrauding Medicare and the Georgia Medicaid programs.
“The use of inducements to obtain referrals from medical professionals jeopardizes the integrity of our health care programs,” said U.S. Attorney Ryan K. Buchanan in announcing the settlement.
Benjamin is to receive $892,000, for bringing the case on behalf of the federal and state governments, the settlement agreement states.
“Being a whistleblower requires great courage and perseverance, and whistleblowers are heroes,” said Raymond L. Moss, partner with Moss & Gilmore LLP, who represented Benjamin in her lawsuit.
Benjamin filed her lawsuit in 2015, listing more than a dozen American Health Imaging facilities in Georgia, Alabama, Florida and Texas among the defendants. Those individual clinics were not listed in the settlement agreement.
Beyond the claims resolved by Monday’s settlement, Benjamin also had alleged in her lawsuit that the company had submitted thousands of fraudulent bills to government health care programs for unauthorized, medically unnecessary and clinically worthless services. The allegations in her suit included that the company was using billing codes that would maximize payments, regardless of the diagnoses or physician orders.
With the settlement, Benjamin agreed to dismiss those claims in her lawsuit.
The defendants denied the allegations the government made, and the settlement made no determination of liability.
In its news release on the settlement, the Department of Justice did not specify how much of the settlement amount would be paid by the company and how much by Arant.
American Health Imaging was acquired by a New York private equity firm — Welsh, Carson, Anderson & Stowe — in September 2019 in a transaction valued at about $250 million. Partnering in the transaction was a North Carolina physician-owned radiology group.
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