Orthopedic clinic must face false claims trial, kickback allegations

Orthopedic

Athens (Ga.) Orthopedic Clinic will have to face trial on some accusations that the practice violated the False Claims Act through kickback-related Medicare and Medicaid claims, according to an order from Georgia's Middle District court.

Rebecca Hockaday, former COO, accused the practice and other defendants of submitting false claims for reimbursement to the Centers for Medicare and Medicaid, according to July 19 court documents. Ms. Hockaday initially made claims based on 54 categories of FCA violations, but that was trimmed down to 31.

Most of the claims were based on violations of the Anti-Kickback Statute, court documents say. Ms. Hockaday found 17 alleged violations leading to false claims. They fell into two categories: "remuneration in the form of compensation, bonuses and buy-in packages to AOC physicians and physician assistants in exchange for referrals to AOC-affiliated surgery centers and ancillary services," and "remuneration in the form of payments and discounts to AOC and its physicians in exchange for referrals of products and services from other companies."

Additional allegations involve Stark Law violations, court documents said. Ms. Hockaday alleged that physician referrals of Medicare and Medicaid patients to the practice's internal health services violated the Stark Law. The practice argued the referrals were allowed because they were under the "in-house ancillary services exception" to the Stark Law and referring physicians didn't have any "prohibited" financial agreements.

When Ms. Hockaday raised concerns over coding and billing, she allegedly faced retaliation and harassment from the practice's physicians, court documents said. In one instance, a physician yelled at her, and another accused her of being "a liar who couldn't be trusted."

A trial will begin Oct. 31. Athens Orthopedic Clinic didn't immediately respond to a July 21 request for comment.

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