A federal jury in the Southern District of Florida convicted a Florida woman on September 14, 2023, for paying kickbacks in exchange for Medicare patient referrals.
According to court documents and evidence presented at trial, the defendant was the owner of a business that provided home health services to Medicare beneficiaries. She hired multiple marketers and paid them kickbacks in exchange for patient referrals. She then caused the submission of claims to Medicare for home health services that were procured through the payment of illegal kickbacks.
The jury convicted her of conspiracy to defraud the United States and pay healthcare kickbacks, and two counts of paying kickbacks in connection with a federal healthcare program. She is scheduled to be sentenced on December 5, and faces a maximum penalty of five years in prison for the conspiracy count, and 10 years in prison for each of the kickback offenses.
The FBI and HHS-OIG investigated the case.
Compliance Perspective
Issue
Under federal and state anti-kickback statutes, you may not knowingly and willfully offer, pay, solicit, or receive anything of value to induce or reward for referrals of federal or state healthcare program business. In some industries, it is acceptable to reward those who refer business to you. In healthcare, however, it is a crime. The prohibition against kickbacks applies to those who pay for referrals and to those who receive them. Kickbacks can take various forms, such as bribes or rebates. They can be given in cash or in kind. Failure to promptly report a kickback can result in lawsuits, fines, and other sanctions.
Discussion Points
- Review policies and procedures for preventing and reporting an anti-kickback violation. Update your policies and procedures as needed.
- Train all staff on federal and state anti-kickback statutes and what can be considered a kickback. Include information on how to report concerns and suspected violations, and make sure staff know that prompt reporting is mandatory. Document that the trainings occurred and place in each employee’s education file.
- Periodically audit staff understanding to ensure that they are aware of what should be done if they suspect an illegal kickback has occurred, whether intentionally or unintentionally. Conduct audits of documentation and billing routinely to prevent and detect errors before they progress to a false claim.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
