Oak Street Health, now a branch of CVS Health, is shelling out $60 million to settle claims suggesting it wasn't playing fair when it came to the rules of Medicare recruitment. They've been accused of offering kickbacks to insurance agents who were successful in getting seniors to sign up at Oak Street's primary care spots. This big payout is an attempt to put to bed allegations that, between 2020 and 2022, Oak Street broke the Anti-Kickback Statute, which is pretty clear on its stance against trading cash or perks for patient referrals under government-funded health programs.
According to the DOJ, Oak Street had this scheme they called the Client Awareness Program where, insurance agents hit up seniors about joining Medicare Advantage and then nudged them Oak Street's way. This program apparently involved something called a “warm transfer," or, the handoff of an interested senior by a three-way phone call or electronically, to someone at Oak Street Health. The DOJ alleges that Oak Street Health paid insurance agents $200 for each person they referred. It was all going well until the government caught wind, reminding everyone that health care choices should hinge on the patient's needs, not some third party's pocketbook.
In the words of HHS-OIG's Special Agent in Charge Mario Pinto, “Kickbacks impose hidden costs on the federal health care system and compromise medical choice and decision-making." Pinto warns that these kickbacks do more than just inflate the costs of healthcare — they taint the sacred decision-making process between a patient and their medical options. Moreover, Acting U.S. Attorney Morris Pasqual for the Northern District of Illinois stated, “Kickbacks, in any form, have no place in our federal healthcare system.” Pasqual assures us that his office is vigilant against such dodgy behavior that threatens to corrupt the system.
One Joseph Stinson got a slice of the whistleblower pie to the tune of $9.9 million for bringing this all to attention under the qui tam provisions of the False Claims Act. That's the part of the law that lets regular Joes sue on Uncle Sam's behalf and pocket a bit of the recovered funds. This scenario was no different, presenting a textbook case of how someone can spotlight wrongdoing and walk away with a decent payday.
This resolution was the fruit of a partnership between the Justice Department's Civil Division and the U.S. Attorney’s Office for the Northern District of Illinois, with a helping hand from HHS-OIG and, the FBI. It's all part of the government's ongoing hustle to root out fraud in healthcare practices.
