Stark, Anti-kickback, False Claims Act and Qui Tam Actions

Healthcare fraud in the United States costs tax payers several billion dollars each year, and the schemes to commit fraud continue to grow in complexity and severity. Violations of healthcare regulations such as the Stark Law and Anti-kickback statute (AKS) pose significant risks to healthcare organizations and professionals, including monetary penalties, litigation costs, business disruption and reputational damage.

Enforcement actions implicating Stark and AKS often focus on the fair market value and commercial reasonableness of the arrangement in question. As one of the oldest and most highly regarded healthcare valuation firms in the county, the valuation experts of VMG Health are uniquely qualified to provide independent analysis and expert testimony regarding the FMV and commercial reasonableness across a broad spectrum of financial arrangements including:

  • Physician compensation
  • Administrative pay and service fee arrangements
  • Business transactions and joint ventures
  • Intellectual property licensing
  • Real estate acquisition, leasing and subleasing
  • Capital asset leasing and equipment use arrangements

Similarly, clients seek out VMG Health’s guidance when there is a regulatory compliance or self-disclosure concern that does not involve an active investigation or enforcement action. VMG experts can work with counsel to assess the potential financial exposure, advise on corrective actions, and help develop safeguards and compliance oversight to mitigate future risks.

Representative Engagements

  • Qui tam matter involving allegations that an ambulatory surgery center (ASC) bought ownership interests from physicians above FMV, and later sold ownership interests to physicians below FMV, in exchange for patient referrals; testified at arbitration hearing
  • Qui tam matter involving allegations that loan terms were not commercially reasonable in exchange for patient referrals
  • Various engagements involving the determination of FMV compensation related to physician services, including clinical services, medical directorships, call coverage, and various consulting arrangements
  • Various engagements involving the determination of FMV compensation related to management services arrangements