Two Kansas men, who are brothers, pleaded guilty to participating in a scheme to defraud a federal healthcare program. According to court documents, each brother entered a plea to one count of conspiracy to defraud the United States.
From January 2017 to April 2019, the brothers utilized four healthcare-related companies they created to enroll to receive Medicare reimbursements for billed medical procedures. They concealed their ownership and control of the businesses on the Medicare enrollment forms and omitted background information about themselves. Each omission was material in determining their eligibility to enroll, rendering all billing reimbursements made by Medicare fraudulent.
One brother had his license to practice chiropractic medicine revoked by the Kansas Board of Healing Arts in 2013 for gross negligence, professional incompetency, and dishonesty. The other brother had his license to practice chiropractic medicine revoked by the Kansas Board of Healing Arts in 2018 for violation of an order, fraud during license renewal, practicing medicine without a license, fraudulent medical records, and failure to maintain records.
As part of their plea agreement, the brothers must pay $3.4 million in restitution.
Compliance Perspective
Issue
Professional licenses should be verified upon hire, and the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) should be checked monthly to ensure no current employees are on the list. Professional license active status should also be tracked regularly. Anyone who hires or partners with an individual or entity on the LEIE may be subject to civil monetary penalties (CMP). Misuse of allocated public funds can be seen as fraud, waste, and abuse of government funds. The Centers for Medicare & Medicaid Services (CMS) requires skilled nursing facilities to have a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under the Social Security Act, and in promoting quality of care. Routine audits should be conducted at each facility on monetary transactions and the results of the audits should be reported to the compliance and ethics committee and to the governing body.
Discussion Points
- Review policies and procedures for verifying the status of professional licenses, including confirming that they are not included on a state or OIG exclusion list. Update as necessary.
- Train appropriate staff to follow protocols for verification of licenses and certifications of employees at the time of hire and on an ongoing basis. Emphasize the importance of maintaining up-to-date licenses and certifications, and ensure that licensed personnel understand their responsibility to notify administration of any changes to their license status. Additionally, conduct regular training sessions to educate all staff about compliance and ethics concerns and their responsibility to report them to supervisors, the compliance and ethics officer,
- Periodically audit to verify that the licensing and certifications of employees are valid and up to date and that OIG LEIE checks are routinely conducted. Immediately address any negative findings. Also periodically perform audits to ensure all staff are aware of the importance of identifying compliance and ethics concerns and their responsibility to report them to their supervisor, the compliance and ethics officer, or via the anonymous hotline.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
