Two Florida women face charges related to a patient referral kickback scheme, according to an indictment announced by the US Attorney’s Office for the Middle District of Florida on July 1, 2024. They were charged with conspiracy to defraud the United States and to pay and receive illegal healthcare kickbacks, and with paying illegal healthcare kickbacks to patient recruiters.
The alleged scheme involved Medicare beneficiaries being referred to a home healthcare company. The company then submitted false and fraudulent claims, totaling over $2 million, for home health services. Defendant 1 was the owner of the company and Defendant 2 was the company’s director of nursing.
The indictment alleges that the two defendants conspired to pay, and paid, patient recruiters per patient referral that the company billed to Medicare. Medicare then paid approximately $1.3 million based on the false and fraudulent claims.
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. 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. It is also illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Filing false claims may result in fines of up to three times the programs’ loss plus $11,000 per claim filed. Under the civil False Claims Act, each instance of an item or a service billed to Medicare or Medicaid counts as a claim, so fines can add up quickly. Facility staff should be knowledgeable in how to report suspicious billing practices.
Discussion Points
- Review policies and procedures for preventing and reporting an anti-kickback violation. Also review your policies and procedures for preventing and reporting a false claim and for conducting a Triple Check Process to verify accuracy of Medicare claims. Update your policies and procedures as needed.
- Train all staff on federal and state anti-kickback statutes and what can be considered a kickback. Also train staff upon hire and at least annually on your compliance and ethics procedures and what can be considered a false claim. 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 or false claim 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.*
