Alleged violations of the federal Anti-Kickback Statute (AKS) are more and more often at the heart of actions involving accusations of health insurance fraud brought under the False Claims Act (FCA). Consider, for example, the amended complaint that was just filed by the U.S. Justice Department to add six physicians as defendants to the original action it filed in April, involving alleged kickbacks and improper laboratory testing claims billed to federal health care programs.

According to the government's amended complaint, the six physician defendants received thousands of dollars in kickbacks in return for their referrals of laboratory testing. The government alleged that laboratories True Health Diagnostics (THD) and Boston Heart Diagnostics Corporation (BHD) conspired with small Texas hospitals, including Rockdale Hospital d/b/a Little River Healthcare (LRH), to pay physicians to induce referrals to the hospitals for laboratory testing, which was then performed by THD or BHD. As alleged, the hospitals paid a portion of their laboratory profits to recruiters, who in turn kicked back those funds to the referring physicians.

The recruiters allegedly set up companies known as management service organizations (MSOs) to make payments to referring physicians that were disguised as investment returns but that actually were based on, and that were offered in exchange for, the physicians' referrals. The complaint alleged that laboratory tests resulting from this referral scheme were billed to various federal health care programs, and that the claims not only were tainted by improper inducements but, in many cases, also involved tests that were not reasonable and necessary.