WASHINGTON — Advanced Pathology Solutions PLLC (formerly known as Advanced Pathology Solutions LLC), an anatomic pathology laboratory headquartered in North Little Rock, Arkansas, and its management services organization, APS MSO LLC (together, “APS”), along with current and former owners Kevin Hannah, Donell Burkett, and Daniel Hunter Pledger have agreed to pay a total of $30 million to the United States to resolve allegations that APS and its owners furnished unlawful kickbacks and ordered medically unnecessary pathology testing services.“Healthcare referrals must be based on the best decision for patients, not the influence of kickbacks,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “This settlement demonstrates the Department’s commitment to hold accountable both corporations and individuals who profit from improper kickback arrangements and who burden federal healthcare programs with claims for medically unnecessary services.”“Fraud against the taxpayer is rampant and insidious and when discovered must be held accountable. Engineering kickbacks to result in unnecessary medical testing which is then paid for by the United States taxpayer is unacceptable and once discovered as with APS, will result in lengthy investigation and review, and ultimately a significant settlement amount as demonstrated by this settlement,” said U.S. Attorney Jonathan D. Ross for the Eastern District of Arkansas. “Our office will continue to work with Main Justice to detect and deter any similar schemes and then hold the wrongdoers accountable under the law.”“Any entity that participates in health care and reaps illicit profits by taking advantage of and violating the trust given by Medicare and Medicaid programs must be held accountable,” said U.S. Attorney Troy Rivetti for the Western District of Pennsylvania. “This settlement is notice that such illegal conduct simply will not be tolerated.”“Kickbacks and medically unnecessary testing don’t just violate the law — they endanger patients and drain critical federal health care funds,” said Acting Deputy Inspector General for Investigations Scott J. Lampert of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “Schemes like this erode trust in the health care system and divert resources away from those who truly need care. HHS OIG will move swiftly and aggressively with our law enforcement partners to uncover these abuses and hold every responsible party accountable.”The settlement resolves allegations made by the United States in a complaint filed on April 8, in the U.S. District Court for the Eastern District of Arkansas. In its complaint, the United States alleged that, from 2015 through July 2022, APS and its owners violated the False Claims Act (FCA) by providing unlawful kickbacks to gastroenterology practices to induce the referral of pathology testing to APS resulting in false claims to federal healthcare programs. The government’s complaint focused on a business model developed by APS and its owners, in which APS set up and managed limited-purpose laboratories (known as “lean labs”) in gastroenterology practices nationwide that enabled the practices to bill for preparing and staining biopsy specimen slides. The complaint alleged that in exchange for various benefits furnished by APS, the gastroenterology practices agreed to exclusively refer their patients to APS by shipping their patients’ slides to APS’s lab in North Little Rock for pathologist interpretation and review. The United States alleged that the arrangements between APS and the gastroenterology practices were improper financial relationships through which APS provided kickbacks to induce the practices to steer their patients to APS.The United States further alleged that APS and its owners submitted and caused the submission of claims to federal healthcare programs for unnecessary testing…
Source: U.S. Department of Justice