Surgeon Will Pay $4.25 Million to Settle Kickback and False Billing Allegations

by Andrew Murray | November 13th, 2019

The Department of Justice made the announcement on October 3, 2019. Community Surgical Associates and Glenn A. Kline, D.O., entered the settlement to resolve allegations “relating to kickbacks received from two hospitals formerly operated by Health Management Associates (HMA) in Lancaster, Pennsylvania, in violation of the False Claims Act and Anti-Kickback Statute.” The Press Release states:

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Dr. Kline’s case is related to a larger investigation under which HMA agreed to pay $260 million to the United States to settle claims arising from HMA’s fraudulent billing practices in multiple healthcare institutions across the United States.

Between 2009 and 2012, as alleged in the relators’ complaint, Dr. Kline practiced as a general surgeon in Lancaster, Pennsylvania. Dr. Kline was a major source of surgical business in the Lancaster area. His ability to refer patients to two former HMA hospitals, Lancaster Regional Medical Center and Heart of Lancaster Medical Center, gave Dr. Kline significant leverage over HMA as it attempted to compete in the Lancaster market.

To secure Dr. Kline’s referrals, the complaint alleges that HMA compensated Dr. Kline by paying him exorbitantly more than the fair market value of his services. Dr. Kline was being paid 300% more than the Medical Group Management Association (MGMA) median salary for comparable general surgeons, and no fair market value analysis was done to support this payment. In addition to his excessive salary, Dr. Kline demanded, and was paid, additional amounts to benefit his practice, Community Surgical Associates. As alleged, Dr. Kline was paid these amounts as kickbacks for his referral of patients to Lancaster Regional Medical Center and Heart of Lancaster Medical Center, which in turn billed federal health care programs for those patients’ services. According to the complaint, these arrangements were intentionally structured to disguise payments which were, in actuality, payments for patient referrals, not for legitimate services.

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The allegations resolved by the settlement were brought in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims and to receive a share of any recovery. George E. Miller and Michael J. Metts, former HMA hospital executives in Lancaster, filed suit in the Eastern District of Pennsylvania, alleging the improper financial relationship between HMA and Dr. Kline. Mr. Miller and Mr. Metts will receive approximately $1,054,000 million as their share of the recovery.

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