A federal jury convicted two Florida doctors for their roles in a scheme to defraud Medicare by submitting over $31 million in claims for expensive durable medical equipment (DME) that Medicare beneficiaries did not need and that were procured through the payment of kickbacks.
According to court documents and evidence presented at trial, Defendant 1 was a chiropractor who conspired with others to steal millions of dollars from Medicare. He owned one of four DME companies that collectively billed Medicare over $31 million for medically unnecessary DME, of which over $15 million was paid. He and his co-conspirators acquired patient referrals and signed doctors’ orders by paying kickbacks to marketers who used overseas call centers to solicit patients and telemedicine companies to procure prescriptions for unnecessary braces for these patients.
Defendant 2 was an orthopedic surgeon who owned one of the DME companies with a previously sentenced co-conspirator and concealed their role in the scheme by putting the DME company in the name of one of Defendant 2’s family members.
Defendant 1 was convicted of conspiracy to commit healthcare fraud, healthcare fraud, conspiracy to pay illegal healthcare kickbacks, paying illegal healthcare kickbacks, and false statements relating to healthcare matters. He is scheduled to be sentenced on April 20 and faces a maximum penalty of 10 years in prison on each of the following counts: conspiracy to commit healthcare fraud; healthcare fraud; and paying illegal healthcare kickbacks. He faces a maximum penalty of five years in prison for the following counts: conspiracy to pay illegal healthcare kickbacks and false statements relating to healthcare matters.
Defendant 2 was convicted of false statements relating to healthcare matters. He is scheduled to be sentenced on April 20 and faces a maximum penalty of five years in prison. A federal district court judge will determine any sentence after considering the US Sentencing Guidelines and other statutory factors.
Their co-conspirator was previously sentenced to over 15 years in prison for his role in the scheme.
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.*
