Criminal prosecutions of providers have been few and far between. Perhaps this investigation is a signal that such prosecutions will be ramped up by the Department of Justice. The New York Times article in which Nolan Auerbach & White Partner, Marcella Auerbach, was quoted, sheds light on a plea of guilty entered by Heather Alfonso, a nurse practitioner in Connecticut, for accepting $83,000 in kickbacks from Insys Therapeutics, an Arizona pharmaceutical manufacturer. Alfonso was a top prescriber of Subsys to Medicare patients. She admitted in her guilty plea that the money she was paid played a part in her prescribing of the drug .
The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b), originated out of concern that payoffs to those who can influence medical decisions will result in medical services being provided that are medically inappropriate, unnecessary, of poor quality or even harmful. This statute prohibits any person or entity from making or accepting payment to induce or reward any person for referring, recommending or arranging for the purchase of any item for which payment may be made under a federally-funded health care program. The statute not only prohibits outright bribes, but also prohibits offering inducements or remuneration that has as one of its purposes the inducement of a physician to refer patients for services that will be reimbursed by a federal healthcare program. The statute ascribes liability to both sides of an impermissible kickback relationship.
More information for potential whistleblowers is located at the Nolan Auerbach & White website.