These services had already been reimbursed as part of the hospital stays. The hospitals also agreed to implement procedures to ensure future compliance with Medicare billing rules. Top of page Kickbacks One of the most complicated and troubling aspects of the health care system involves hidden financial arrangements between various health care providers. There are a variety of improper arrangements where providers will provide some material benefit in return for other providers prescribing or using their products or services. In some instances, such arrangements are illegal.
Kickbacks often result in medically unnecessary treatment.
In cases where a kickback arrangement results in the government paying for medically unnecessary services or in the government being overcharged, a case under the False Claims Act may be appropriate. Investigation showed that in most cases the research performed by the physicians was not of scientific value. In addition, some physicians never completed the research but received full payment from the pharmaceutical company. The company entered criminal pleas in Ohio and Minnesota and agreed to cooperate in an investigation of individuals involved in the schemes, including physicians. Top of page False Certifications and Information Health care providers who submit Medicare and Medicaid claims containing false statements also may be liable under the False Claims Act.