The United States contends that, between 1996 and 2005, Cox entered into financial relationships with referring doctors at a local physician group and engaged in improper Medicare billing practices.
Under the Stark statute, Medicare providers like Cox cannot bill Medicare for referrals from doctors with whom the providers have a financial relationship, unless that relationship falls within certain exceptions.
Cox may have also violated the anti-kickback statute by offering inducements to providers in return for patient referrals.
The $60 million payment will resolve these claims and also claims that Cox performed improper billings for services provided to dialysis patients and submitted fraudulent Medicare cost reports. Because these reports employed an improper method of reporting its medical clinics’ overhead, they resulted in claims for non-reimbursable clinic costs.
"The Justice Department is committed to ensuring that the best interests of federal health care program patients are not compromised by unlawful payments to physicians," said Gregory G. Katsas, assistant attorney general for the DOJ’s civil division, according to a release from the DOJ. "The resolution of this matter resulted in a significant recovery for taxpayers, and it exemplifies our dedication to vigorous enforcement of the Stark and anti-kickback statutes."
Cox will pay $35 million immediately, followed by five yearly payments of $5 million (plus 4 percent interest).
