In June, the U.S. District Court for the Northern District of Illinois held that a medical management company (MPI) violated the Anti-Kickback Statute (AKS), False Claims Act, and Illinois False Claims Act.
In June, the U.S. District Court for the Northern District of Illinois held that a medical management company (MPI) violated the Anti-Kickback Statute (AKS), False Claims Act, and Illinois False Claims Act by paying a community care organization (HCI) for access to the personal information of clients in order to market Medicare-reimbursed healthcare services to those clients. The court held that under a “file access theory” of referral, the defendants violated the AKS, which makes it a crime to knowingly and willfully pay any remuneration in exchange for referrals of items or services reimbursable under a federal healthcare program. The case is Stop Illinois Health Care Fraud, LLC v. Asif Sayeed, Physician Care Services, S.C., Management Principles, Inc., & Vital Home & Healthcare, Inc., No. 12-CV-09306, 2021 WL 2331338 (N.D. Ill. June 8, 2021).
Given the court’s apparent openness to an expansion of the concept of “referral” under the AKS and the endorsement of the “file access theory,” any management company, care management company, trade association, or other organization with paid access to client lists should consult with an experienced healthcare attorney in order to ensure such an arrangement is not a violation of the AKS.