DOJ: Physicians to be next target in lab probe
DOJ: Physicians to be next target in lab probe
Although the federal government’s crackdown on clinical laboratories so far has focused mostly on the labs themselves, the second stage of the initiative probably will focus on the large number of physicians whom Justice Department investigators claim accepted kickbacks in exchange for referrals to those labs.
Indeed, physicians are an integral part of the spate of recent settlements between the DOJ and clinical labs over the issue of illegal kickbacks. (See related story on the latest and potentially the largest settlement, p. 4.) Even so, given the astronomical sums clinical labs are agreeing to pay, physicians may feel they’ve slipped below the government’s radar on this one.
But that isn’t the case, says Michael Loucks, JD, chief of the health care fraud unit at the U.S. Attorney’s Office in Boston. Loucks is a key player in settlement talks with Lexington, MA-based lab company Fresenius Medical Care North America. "The perception may be that the U.S. Attorney’s Offices focus more on the payer [in kickback cases]," Loucks says. "But very often, the perceived bad guy can be the payee — the physician who receives the money in exchange for referral or service. That’s because the physician is often seen as the one who has some control over where patients obtain a subsequent medical service, like a drug, a medical device, or a course of treatment that the physician can’t provide."
Even so, Loucks admits that DOJ investigators don’t bother investigating physicians unless someone’s made a specific allegation against them, or unless investigators come across damaging evidence against a physician as part of a separate investigation.
For example, if the DOJ investigates a clinical laboratory, it may come across records suggesting a certain physician has received inducements in exchange for referrals. "In that circumstance, we’ll investigate it, but we don’t go looking unless we have an allegation, whether it be from the doctor’s staff, the clinical laboratory’s staff, or some competitor," Loucks says.
Another way DOJ investigators track down physician misconduct is examining medical sales reps’ call reports, Loucks adds. "That can be a fruitful source of evidence," he says. Essentially, after sales people pay a call to a physician’s office, possibly for the purpose of selling laboratory services or other supplies, they typically take notes on what transpired during the meeting.
"Salespeople generally don’t have the ability on their own to give something to a physician; they don’t have the budget," Loucks says. "So they have to get approval from somebody else. And it’s surprising how often a paper trail is left."
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