Waterloo, Iowa. Population 70,000 (give or take). Who would expect that this town would be the focal point of one of the biggest physician compensation/Stark Law settlements in history.
In 2009, Covenant Medical Center in Waterloo agreed to pay the Federal government $4.5 million to settle charges that it had overpaid five doctors. The Stark Law is violated if a physician is paid in excess of fair market value for services or if the compensation is not commercially reasonable.
The Affordable Care Act made it clear that Stark Law violations can trigger liability under the Federal False Claims Act. The result is that amounts that are billed under the “cloud” of Stark can lead to treble damages plus up to $11,000 per claim. If the Stark Law violation involves payment in excess of fair market value to a physician, the basis for assessing damages can be three times the amount of the physician’s billing plus up to $11,000 for each claim. The application of the False Claims Act to Stark Law violations has placed a renewed focus on physician compensation issues.
In the Covenant care, the government alleged that the five physicians were paid commercially unreasonable compensation, far in excess of fair market value. The hospital denied any wrongdoing but paid the government $4.5 million plus interest to settle the claims.
Physician compensation has become a more sensitive issue than it ever was in the past. The Waterloo, Iowa case demonstrates that smaller towns are not immune from the impact of the Stark Law and False Claims Act.