The U.S. Department of Justice has announced a healthcare fraud settlement with Aurora Health Care. The health system based out of Wisconsin accepted the healthcare fraud settlement decision after they were accused of fraud and abuse associated with compensation arrangements in place with two physicians.

The integrated health system associated with the healthcare fraud settlement agreed to pay $12 million to state and federal governments to end the allegations against them.

In a press release, the U.S. Attorney’s Office in the Eastern District of Wisconsin shared that Aurora Health Care, allegedly violated the Stark Law by entering into compensation agreements with two different doctors in which the arrangements exceeded fair market value.

The health care fraud settlement had to do with allegations of the violation of the federal health care fraud and abuse laws falling under the umbrella of the Stark Law.

The Stark Law forbids a practice known as self-referral in cases where an immediate family member or the physician themselves has a financial relationship with the entity being recommended for the patient’s treatment. Financial relationships can include indirect or direct ownership or a financial stake like investment benefits held by the referring physician.

According to the U.S. Attorney’s office speaking out about the health care fraud settlement, these arrangements violated the Stark Law because there were physicians inside the health system who had an improper financial relationship. The health system accepting the healthcare fraud settlement terms also allegedly violated the False Claims Act, according to details from the U.S. Attorney’s office.

As the use of Medicaid and Medicare programs have grown, so too have the instances of fraud for the healthcare providers submitting claims. One U.S. Attorney shared that more than $1 trillion is spent on Medicaid and Medicare healthcare programs and that fraud and abuse run rampant, leading the Justice Department to investigate any claims of healthcare fraud quite seriously.

A healthcare fraud settlement could be brought about as a result of a whistleblower who has inside information about instances or schemes involving fraud. Since so many people rely on support from federal healthcare programs and since abuse has become such a key issue, whistleblowers are encouraged to take action if they have evidence of fraud.

When an employee at an affiliated company becomes aware of fraudulent actions and schemes, they might have grounds to file a whistleblower lawsuit. The DOJ then gets a chance to investigate, and it may intervene in a federal case against the identified parties.

A whistleblower who brings a claim under False Claims Act could be entitled to recover compensation as part of his or her role in making the federal government aware of these issues. More than 600 individuals were charged with healthcare fraud and abuse crimes in 2018, catching individuals that were involved in fraudulent schemes affecting Medicare and Medicaid for more than $2 billion.