A $4 million settlement by Lakeland Regional Medical Center (LRMC) in Lakeland, Florida, alerts other health care providers and state and local governments administering Medicaid-funded care to confirm their arrangements don’t involve prohibited donations.
Under federal law, a state’s share of Medicaid payments must consist of state or local government funds, and may not come from “non-bona fide donations” from private health care providers, such as hospitals.
A non-bona fide donation is a payment in cash or in kind from a private provider to a governmental entity that is then returned to the private provider through a payment by Medicaid.
Because Medicaid services are reimbursed jointly by the federal and state governments, a non-bona fide donation causes federal expenditures to increase without any corresponding increase in state expenditures, since the state share of the Medicaid payments to the provider comes from and is returned to the provider. The prohibition of this practice ensures that states are in fact paying a share of Medicaid payments and thus have an incentive to curb Medicaid costs and prevent unnecessary services.
On March 30, the Justice Department announced that LMRC has agreed to pay the United States $4 million to resolve allegations that it made prohibited donations to a local unit of government to improperly fund the state’s share of Medicaid payments to LRMC.
According to the Justice Department between October 2014 and September 2015, LRMC made improper, non-bona fide donations to Polk County, Florida by assuming and paying certain of Polk County’s financial obligations to other healthcare providers. These donations were designed to increase Medicaid payments received by LRMC, by freeing up funds for the County to make payments to the State as the state share of Medicaid payments to LRMC. This state share was “matched” by the federal government before being returned to LRMC as Medicaid payments. The Medicaid payments LRMC received were thus funded by the federal government and LRMC’s own donations, in violation of the prohibition on non-bona fide donations.
We hope this update is helpful. For more information about these or other health or other legal, management or public policy developments, please contact the author Cynthia Marcotte Stamer via e-mail or via telephone at (214) 452 -8297.
Solutions Law Press, Inc. invites you to receive future updates by registering on our Solutions Law Press, Inc. Website and participating and contributing to the discussions in our Solutions Law Press, Inc. LinkedIn SLP Health Care Risk Management & Operations Group, HR & Benefits Update Compliance Group, and/or Coalition for Responsible Health Care Policy.
About the Author
Recognized by her peers as a Martindale-Hubble “AV-Preeminent” (Top 1%) and “Top Rated Lawyer” with special recognition LexisNexis® Martindale-Hubbell® as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Labor & Employment,” “Tax: ERISA & Employee Benefits,” “Health Care” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is a practicing attorney board certified in labor and employment law by the Texas Board of Legal Specialization and management consultant, author, public policy advocate and lecturer widely-known for 35 plus years of health industry and other management work, public policy leadership and advocacy, coaching, teachings, and publications.
A Fellow in the American College of Employee Benefit Counsel, Chair of the American Bar Association (“ABA”) International Section Life Sciences and Health Committee, Chair-Elect of the ABA TIPS Section Medicine & Law Committee, Past Chair of the ABA Managed Care & Insurance Interest Group, Scribe for the ABA JCEB Annual Agency Meeting with HHS-OCR, past chair of the ABA RPTE Employee Benefits & Other Compensation Group and current co-Chair of its Welfare Benefit Committee, Ms. Stamer is most widely recognized for her decades of pragmatic, leading-edge work, scholarship and thought leadership on health and managed care and employer benefits legal, public policy and operational concerns in the healthcare, employer benefits, and insurance and financial services industries. She speaks and publishes extensively on HIPAA and other related compliance issues.
Ms. Stamer’s work throughout her career has focused heavily on working with health care and managed care, health and other employee benefit plan, insurance and financial services and other public and private organizations and their technology, data, and other service providers and advisors domestically and internationally with legal and operational compliance and risk management, performance and workforce management, regulatory and public policy and other legal and operational concerns.
For more information about Ms. Stamer or her health industry and other experience and involvements, see www.cynthiastamer.com or contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.
About Solutions Law Press, Inc.™
Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested in reviewing some of our other Solutions Law Press, Inc.™ resources available here such as:
- Medical Professionals, Medical Businesses Owners and Others Criminally Charged In $490 Million Plus COVID-19 Related False Billings Takedown
- Sibley Hospital & Johns Hopkins Health System Pay $5 Million To Settle Stark Violations
- HHS Inspector General Comments Signal MorrContinuAggressive Ahgh￼inued Aggresdiv
- 4/21 Deadline For Comments On Proposed HIPAA Administrative Simplification Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification To Referral Certification and Authorization Transaction Standard
- Pharmaceutical Distributor Danco’s $765,000 False Claims Act Settlement Shows Importance Of Customs Marking and Duty Rules
- $400K EEOC Settlement Warns Health Care Organizations Against Pregnancy Discrimination
- 2 Pharmacy FCA Convictions WarnAgainst Billing Or Undelivered Drugs Or Care
- “Rock Doc” Opioid Conviction Reaffirms DOJ Prioritization & Frequent Success of Illegal Opioid Distribution Enforcement
- Health Care Provider Pays $4 Million For Making Prohibited Donations Toward County Medicaid Funding
- OIG Asks Cigna MA Plans To Refund $6 Million, Clean Up Plan Processes After Poor Audit Results
- FY 2022 Medicaid Fraud Conviction Increase, Other Data Shows Continued Robustness of Federal Medicaid Enforcement
- Health Care Providers Should Verify Compliance, Audit Risks In Preparation For End of COVID Flexibilities
- Prepare To Handle Justice Department Marijuana Pardon Certificates From Applicant
- Sentencings & Charges Of Clinic Operators For Defrauding Health Plans Highlight Risks Of Involvement In Schemes To File Fraudulent Health Benefit Claims
- Former Missouri Lawmaker Sentenced On COVID & Stem Cell Fraud, Illegally Distributing Prescription Drugs & False Statements
- Ensure Health Care & Other Compliance Practices Updated For New DOJ Voluntary Disclosure Policy
- F-1 Visa Guidance Could Impact Health Industry Work Eligibility Of Some Foreign Students
- DOJ Withdraws Health Care Antitrust Policy & Enforcement Statements
IMPORTANT NOTICE ABOUT THIS COMMUNICATION
If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.
NOTICE: These statements and materials are for general informational and educational purposes only. They do not establish an attorney-client relationship, are not legal advice or an offer or commitment to provide legal advice, and do not serve as a substitute for legal advice. Readers are urged to engage competent legal counsel for consultation and representation in light of the specific facts and circumstances presented in their unique circumstances at any particular time. No comment or statement in this publication is to be construed as legal advice or an admission. The author and Solutions Law Press, Inc.™ reserve the right to qualify or retract any of these statements at any time. Likewise, the content is not tailored to any particular situation and does not necessarily address all relevant issues. Because the law is rapidly evolving and rapidly evolving rules make it highly likely that subsequent developments could impact the currency and completeness of this discussion. The author and Solutions Law Press, Inc.™ disclaim, and have no responsibility to provide any update or otherwise notify anyone of any such change, limitation, or other condition that might affect the suitability of reliance upon these materials or information otherwise conveyed in connection with this program. Readers may not rely upon, are solely responsible for, and assume the risk and all liabilities resulting from their use of this publication. Readers acknowledge and agree to the conditions of this Notice as a condition of their access to this publication.
Circular 230 Compliance. The following disclaimer is included to ensure that we comply with U.S. Treasury Department Regulations. Any statements contained herein are not intended or written by the writer to be used, and nothing contained herein can be used by you or any other person, for the purpose of (1) avoiding penalties that may be imposed under federal tax law, or (2) promoting, marketing or recommending to another party any tax-related transaction or matter addressed herein.
©2023 Cynthia Marcotte Stamer. Limited non-exclusive right to republish granted to Solutions Law Press, Inc.™