A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution.
Between 2017 and 2019, the Missouri woman owned and managed several durable medical equipment (DME) companies. Her companies paid kickbacks for orders and prescriptions signed by telemedicine doctors and nurse practitioners, who in nearly all the cases did not examine the patients, had no contacts with the patients, and did not otherwise determine that the patients needed DME.
The DME companies would then submit the reimbursement claims to Medicare and Medicaid. In response to the fraudulent claims submitted by the Missouri woman and her co-conspirators, Medicare and Medicaid reimbursed the DME companies for the medically unnecessary equipment. In many of the cases, the patients received DME equipment from several DME companies, none of which they had requested or needed.
Curt L. Muller, Special Agent in Charge with the Department of Health and Human Services, Office of Inspector General stated, “Submitting false claims for medically unnecessary equipment diverts funding from the necessary services required to support beneficiaries of federal health care programs. OIG will continue to work with our law enforcement partners to identify and hold accountable individuals who choose to waste vital taxpayer dollars by participating in health care fraud schemes.”
Compliance Perspective
Issue
All members of the healthcare team should be knowledgeable of what may be considered a false claim or an illegal kickback. Confirm that all staff are aware that a violation can be illegal, whether it is intentional or not intentional. Submitting a false claim or receiving an illegal kickback, or failure to report these violations, can result in fines and other sanctions, including placement on the OIG List of Excluded Individuals and Entities.
Discussion Points
- Review your policy and procedure for preventing and reporting false claims, kickbacks, or other fraud, waste, and abuse violations. Update your policies and procedures as needed.
- Train all staff on the False Claims Act and the Anti-Kickback Statute. Include information on how to report concerns and suspected violations, and that prompt reporting is mandatory. Document that the trainings occurred and place in each employee’s education file.
- Periodically audit to ensure that staff are aware of what should be done if they suspect a false claim or an illegal kickback has occurred, whether intentionally or unintentionally. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 1 Compliance and Ethics Program, CP 2.3 General Legal Duties and Antitrust Laws.
FOR MORE INFORMATION ON THIS TOPIC VIEW: FRAUD MODULE 3 – MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS.
