Many providers are skeptical that the government really enforces the Stark statute. In a first of its kind settlement, Covenant Medical Center in Iowa agreed to pay the government $4.5 million to resolve false claims act allegations originally lodged by competitors of the physicians the Medical Center had recruited and to whom they were paying extremely high salaries as employees. The really unusual aspects of the settlement were that it was with the Department of Justice which cited the Stark statute violations as the basis for the settlement because the salaries were the highest in Iowa and among the highest in the United States for physicians. The US Attorney has refused to reveal what he used to determine fair market value but he did not cite MGMA compensation data as the basis for the determination. The Stark statute requires fair market value for a bona fide employment relationship compensation to qualify under the exception.