An owner and operator of a Texas Medical Clinic has been ordered to serve a total of 300 months in federal prison to be immediately followed by three years of supervised release. The sentence was handed down on May 4, 2021, following guilty verdicts of conspiracy and aiding and abetting healthcare fraud in her January 2019 trial.
At the owner and operator’s trial, the jury heard how she paid doctors to approve patients for home healthcare regardless of whether it was medically necessary. In addition, she also sold those approvals to various corrupt home healthcare providers. Those providers then billed Medicare for services that were either unnecessary or never provided.
During the trial, the jurors watched video that captured the fraud committed by the owner and operator at the medical clinic. When the guilty verdict was handed down, the court noted that as part of a larger conspiracy, the owner and operator was responsible for all of the loss to taxpayers the scheme generated.
The OIG and the FBI jointly investigated this case. As a result of the investigation and prosecution, several doctors and administrators have also been convicted of crimes ranging from Medicare fraud to the payment of kickbacks.
The Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, the Centers for Medicare & Medicaid Services (CMS), working in conjunction with the Office of Inspector General (OIG), is taking steps to increase accountability and decrease the presence of fraudulent providers.
Compliance Perspective
Issue
All members of the healthcare team should be aware of what may be considered a false claim or a kickback. Ensure that all staff are aware that these violations can occur whether they are intentional or unintentional. Failure to promptly report a false claim or kickback can result in lawsuits, fines, and other sanctions. 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.
Discussion Points
- Review policies and procedures for preventing and reporting a false claim or anti-kickback statute violations. Update your policies and procedures as needed.
- Train all staff on the False Claims Act and Anti-Kickback Statute and what can be considered a false claim or kickback. 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 staff to ensure that they are aware of what should be done if they suspect a false claim or 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.
FOR MORE INFORMATION ON THIS TOPIC VIEW: FRAUD MODULE 3 – MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS.
