The United States Department of Justice (DOJ) and National Interventional Radiology Partners (NIRP) recently announced an $8.8 million settlement that resolves allegations that the company violated the federal False Claims Act (FCA) and Anti-Kickback Statute (AKS). The government alleged that NIRP and Dr. Andrew Gomes, founder and CEO of NIRP, illegally paid physicians for referrals to clinics to surgically treat patients with peripheral arterial disease (PAD).
According to the government, starting in 2015, Gomes established clinics throughout Texas under the NIRP umbrella, with the intent to surgically treat PAD. Capital for the clinics was raised from physicians who had medical practices that could provide a strong patient base of Medicare referrals – including primary care practitioners and podiatrists. Gomes’ allegedly pitched the investor physicians by promising high returns on their investment in each surgical center by referring many patients for treatment. Gomes also allegedly said that more patient referrals would lead to more revascularization surgeries and greater profits, which would go back to the investors as dividends. In the pitch, Gomes also told the investing physicians that once the clinics were up and running, they could be sold, creating additional value for investors.
The complaint was initially filed under the qui tam provisions of the FCA by a Texas physician with information about the scheme. For his role in the claim, the relator will receive roughly $1.6 million. As we often see, the claims resolved by the settlement are only allegations and there has been no determination of liability.
“Medical providers and others who unlawfully accept kickbacks for patient referrals undermine the integrity of medical decision-making and waste taxpayer dollars,” said Special Agent in Charge Jason E. Meadows of Department of Health and Human Services-Office of Inspector General (DHHS-OIG). “We remain committed to working with our law enforcement partners and prosecutors to hold those who defraud Medicare accountable and restore the integrity of the Medicare trust fund.”
“Healthcare providers that pursue patient referrals through improper financial arrangements will be held accountable,” said U.S Attorney Alamdar S. Hamdani. “These types of improper financial arrangements corrupt medical decision making, increase costs and undermine the integrity of federally funded health programs. Patients deserve care based upon their specific medical needs and not on an individual physician’s financial interest or gain.”