Assure: Monitoring Revenue Routed to Referring Surgeons

In the Assure neuromonitoring kickback settlement, Assure agreed to pay $1,008,000 to resolve allegations that it routed monitoring revenue to surgeons to win their referrals. The government described a business in which the surgeon ordering a service could receive part of the money paid for it. If you know the monitoring orders or the venture’s accounts, you may recognize the connection between the clinical decision and the money that came back.

The U.S. Attorney’s Office for the District of Colorado announced the civil settlements on December 3, 2024. The settlements totaled more than $2 million and covered Denver-based Assure Holdings Corp., its subsidiary Assure Neuromonitoring LLC, the company’s founder, a Denver neurosurgeon and a California businessman. The alleged payment route ran through a joint venture called Englewood Professional Reading LLC.

How the Monitoring Service Worked

Intraoperative neuromonitoring uses electrodes to monitor a patient’s nervous system during surgery. The government’s account describes a technician in the surgical suite placing the electrodes before the operation, while an oversight physician elsewhere remotely monitors the data as the surgeon operates.

That division of work matters to the payment story. The surgeon chooses the monitoring service, the technician works beside the patient, and the oversight physician performs the remote monitoring. In the Assure allegations, payments for that oversight physician’s work supplied the revenue that moved through Englewood.

How Englewood Routed Revenue to the Surgeon

The government alleged that Assure used joint-venture companies to pay surgeons for ordering its monitoring services. Its account of the Denver neurosurgeon describes how the money reached the person making that choice.

At the surgeon’s request, a friend formed a company that entered a joint venture with Assure’s founder. The venture was Englewood Professional Reading. According to the government, Englewood received payments for oversight-physician claims, and a series of transactions routed part of those payments to the surgeon.

The government alleged that the joint venture paid the surgeon for sending monitoring business to Assure. The person ordering the service allegedly benefited from the payment for another physician’s work.

We examine the relationship between the orders and the transfers with you, including how the payments were described and who benefited from them. A venture agreement can describe the business on paper. An insider can explain how the arrangement actually operated.

Where the Claims Went

The government alleged that federally funded health care programs paid claims resulting from the kickbacks. Medicare and Colorado Medicaid were among the programs footing the bill.

When the neurosurgeon ordered monitoring through Assure, Assure caused a third-party billing company to submit claims on Englewood’s behalf to the patient’s insurer. Some went to Medicare Advantage organizations responsible for covering Medicare beneficiaries. In other instances, oversight physicians arranged by Assure submitted their own claims directly to Medicare or Colorado Medicaid.

For someone in billing, the distinction is concrete: some claims went out in the venture’s name through a billing company, while others went directly from the oversight physician to a government program.

That is why knowledge from the billing side can matter as much as knowledge from the operating room. The order explains how the service was selected. The claim and payment trail explain whose monitoring work was billed and where the resulting money went.

Why Is Kickback Illegal?

The Anti-Kickback Statute prohibits knowingly paying or receiving benefits to induce referrals for services covered by federal healthcare programs. As the Assure announcement explains, the purpose is to keep medical decisions focused on patients’ interests instead of improper financial incentives. Claims for services resulting from those kickbacks can also violate the False Claims Act.

A review in the Journal of Forensic and Investigative Accounting makes a useful distinction between a referral payment and an injury to the patient:

In Assure’s case, the government’s allegation centered on paying the surgeon who chose the monitoring provider.

Physician-Owned Ventures Tie Income to Orders

A physician-owned distributorship earns revenue from implantable devices ordered by its physician-owners for their own patients. The HHS Office of Inspector General’s Special Fraud Alert on physician-owned entities explains why this structure matters: surgeons can strongly influence which implant a hospital or surgery center buys. Ownership can put the person choosing the product on the selling side of the transaction too.

The Reliance Medical Systems settlement concerned alleged referral-based distributions through physician-owned implant distributors. The government also alleged that physicians who generated insufficient referrals were terminated from the distributorships. That allegation tied the physician’s continuing financial opportunity to the business the physician brought in.

Assure’s alleged arrangement drew on monitoring fees rather than implant profits. The shared question is how the physician’s financial return connects to the physician’s choice.

What the MedNet Case Shows

The MedNet case concerned alleged payments to physicians to use remote cardiac monitoring services. It provides a closer comparison to Assure’s referral-payment theory, involving a different kind of monitoring.

The Separate Settlements and Whistleblower Share

Alongside Assure’s company settlement, the neurosurgeon agreed to pay $650,000 and the founder agreed to pay $225,000. The founder’s amount reflected his financial condition and limited ability to pay. The announcement separately reported that the businessman had paid $125,000.

The settlements also resolved a whistleblower’s qui tam claims under the False Claims Act. The announcement said the whistleblower would receive 18% of the settlement proceeds.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know How the Monitoring Money Moved

If you saw monitoring orders turn into payments for the surgeon making them, speak with our whistleblower experts about how the monitoring money moved. We work with you to build your strongest whistleblower case, bring in healthcare fraud whistleblower lawyers who understand referral-payment arrangements, and remain your partners throughout the case.