Aurora Health Care has agreed to pay $12 million to the United States and state of Wisconsin to settle allegations that it submitted claims to Medicare and Medicaid in violation of federal law.
The U.S. Attorney’s Office for the Eastern District of Wisconsin announced the settlement today.
The federal government and state alleged Aurora entered into compensation arrangements with two physicians that exceeded the fair market value of the physicians’ services, took into account their anticipated referrals and were not for identifiable services.
The alleged improper compensation, which occurred during certain periods from 2008 to 2012, was in violation of federal law prohibiting physician self-referral. Aurora allegedly submitted claims for services ordered by the two physicians to Medicare and Medicaid, in violation of the federal False Claims Act.
“Each year, federal and state governments spend over a trillion dollars on health care programs like Medicare and Medicaid,” said U.S. Attorney Matthew Krueger. “This settlement reflects the U.S. Department of Justice’s commitment to using all available legal tools to ensure those health care dollars are spent wisely.”
Aurora Health Care released a response Wednesday:
“This case is related to a technical requirement involving a compensation arrangement designed a decade ago. We have robust policies and protocols in place to ensure compliance, and we hold ourselves to the highest standards. Our top priority, along with that of our physicians, remains providing the highest quality care to those we are so privileged to serve.”
A whistleblower complaint filed under the False Claims Act helped initiate the investigation into the alleged improper compensation, but those original claims were unrelated to the settlement agreement. The whistleblowers will receive a share of the settlement amount and will ask the district court to dismiss their complaint.
The investigation was assisted by the Federal Bureau of Investigation, Office of Inspector General of the U.S. Department of Health and Human Services, the Defense Criminal Investigative Service and Wisconsin Department of Justice Medicaid Fraud Control & Elder Abuse Unit.
