According to the Justice Department, Aurora—which is part of Advocate Aurora Inc. and operates in Wisconsin, Illinois and the upper peninsula of Michigan—allegedly entered into compensation arrangements between 2008 and 2012 with two doctors "that were not commercially reasonable" and exceeded fair market value of the physicians' services.
They said Aurora took into account the physicians' anticipated referrals. Aurora is accused of then submitting claims to Medicare and Medicaid for services ordered by those physicians. Those actions are allegedly in violation of the Stark Law, which blocks the government from paying for services ordered by physicians with improper financial relationships with entities to whom they refer patients, and the False Claims Act, which bars an entity from knowingly submitting such claims to the government for payment.
"This $12 million settlement demonstrates how these violations have a significant and direct economic impact on the healthcare industry," said FBI Special Agent in Charge Justin Tolomeo in a statement. "Our priority is to protect consumers and hold accountable those in the healthcare system who misuse the Medicare and Medicaid programs."
The investigation that discovered the allegedly improper compensation arrangements resulted from a whistleblower lawsuit, and whistleblowers will recover a portion of the settlement.