Massachusetts Eye and Ear Agrees To Pay $5.7 Million: The United States Attorney’s Office District of Massachusetts announced on May 24, 2023 that Massachusetts Eye and Ear Infirmary, Massachusetts Eye and Ear Associates, Inc., and the Foundation of the Massachusetts Eye and Ear Infirmary, Inc. (collectively “Massachusetts Eye and Ear”) have agreed to pay over $5.7 million to resolve allegations that seven of their physician compensation plans, involving 44 doctors, violated federal law.
The government alleged that Massachusetts Eye and Ear compensated 44 physicians in a manner that violated the Physician Self-Referral Law (sometimes referred to as the Stark Law). Mass General Brigham, which has owned and operated Massachusetts Eye and Ear since April 2018, disclosed this issue to the government in connection with the government’s investigation into related allegations. The Stark Law prohibits physicians from referring patients to receive “designated health services” payable by Medicare from entities, like hospitals, with which the physician has a financial relationship, unless the arrangement falls into the exceptions provided for by law. It also prohibits the entity from billing Medicare for those services. The law is intended to ensure that physicians’ medical judgments are not compromised by improper financial inducements.
All seven physician compensation models at issue began before Mass General Brigham acquired Massachusetts Eye and Ear. One physician compensation model ended before Mass General Brigham took control of Massachusetts Eye and Ear. Mass General Brigham voluntarily terminated the remaining six physician compensation models on Oct. 1, 2019.
The government’s investigation was prompted by False Claims Act allegations brought in a lawsuit filed by a whistleblower under the qui tam provisions of the False Claims Act. Under those provisions, a private party can file an action on behalf of the government and share in any recovery. In connection with today’s settlement, the whistleblower will receive 17% of the recovery.
An Acting United States Attorney stated with regard to the settlement, “Stark Act violations drive up the overall costs of the health care system due to fraud and abuse. We will continue to vigorously investigate False Claims Act violations arising out of improper financial relationships between hospitals and physicians. We applaud Massachusetts Eye and Ear for its cooperation with the Department’s investigation. This settlement agreement demonstrates the advantages that actors can enjoy when they disclose non compliance, and we encourage others in the health care industry to come forward when they suspect wrongdoing.”
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publicly known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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