The Office of Inspector General (OIG) announced a $7.3 million civil monetary penalty settlement with United Shockwave Services, United Prostate Centers and United Urology Centers (collectively, "United") for alleged violation of the federal anti-kickback and Stark laws. United, owned by physicians, provided lithotripsy and laser services to hospitals. The OIG alleged that United leveraged patient referrals to obtain contracts with hospitals located in Illinois, Indiana and Iowa, threatening to refer patients to competing hospitals in the absence of a contract and promising additional referrals to contracted hospitals. The OIG also alleged that the contractual relationships resulted in violations of the Stark Law. Finally, the OIG examined the relationships between United and the physician-investors, noting that physicians who produced more referrals were offered more shares, and those who did not were asked to divest their interests.

United entered into a five-year CIA in conjunction with the settlement. The settlement reflects the increasing focus on healthcare fraud investigations in general, and hospital/physician relationships in particular. The settlement also indicates that the OIG will examine the internal relationships between physician-investors and the companies in which they hold interests.