On September 18, the U.S. Department of Justice announced that Oak Street Health agreed to pay $60 million to settle allegations that it violated the Anti-Kickback Statute and False Claims Act by paying kickbacks to third-party insurance agents in exchange for referring seniors to Oak Street Health’s primary care clinics.
The DOJ alleges that Oak Street Health developed a scheme in which insurance agents c”ontacted seniors eligible for or enrolled in Medicare Advantage” and “delivered marketing messages designed to generate interest in Oak Street Health.” Oak Street Health paid insurance agents $200 per beneficiary referred or recommended according to the DOJ.
“These payments incentivized agents to base their referrals and recommendations on the financial motivations of Oak Street Health rather than the best interests of seniors,” the DOJ alleges.
The settlement resolves a qui tam lawsuit filed by whistleblower Joseph Stinson. The False Claims Act’s qui tam provisions enable private citizens and private parties to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery.
Stinson is set to receive $9.9 million.
“Health care providers that attempt to profit from kickbacks will be held accountable,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We are committed to rooting out illegal practices committed by Medicare Advantage providers, insurance agents and brokers that undermine the interests of federal health care programs and the patients they serve.”
“Kickbacks, in any form, have no place in our federal healthcare system” said Acting U.S. Attorney Morris Pasqual for the Northern District of Illinois. “My office is alert for kickbacks that can subvert patient choice and defraud federal health care programs. This investigation and settlement help to ensure that patient choice is prioritized above a provider’s bottom line.”
In July 2023, a bipartisan group of senators introduced the False Claims Amendments Act of 2023, which address a few technical loopholes undermining the success of the FCA. The bill is widely supported by whistleblower advocates.
National Whistleblower Center (NWC) has issued an Action Alert calling on Congress to pass the bill.
Join NWC in Taking Action:
Demand that Congress strengthen the False Claims Act
Further Reading:
Bipartisan Legislation Unveiled to Strengthen False Claims Act