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Home Care
Providers Indicted for Paying Kickbacks for Referrals
Elizabeth
E. Hogue, Esq.
Office:
877-871-4062
Fax:
877-871-9739
E-mail:
ElizabethHogue@ElizabethHogue.net
On December 18,
2008 a federal grand jury indicted owners and employees of eight home health
agencies in the Metro-Detroit area on charges that they took part in a plan to
solicit and pay kickbacks in exchange for Medicare patient referrals. This plan
was devised by Rebecca Sharp, president of Continuing Senior Care, Inc. in
Ypsilanti, Michigan, who allegedly received over $1.1 million in kickbacks.
According
to the indictment, Sharp obtained potential home health patients by directing
her staff to randomly telephone senior citizens in order to offer them medical
services and chore workers. If any senior citizen was curious as to how
Continuing Senior Care received his or her contact information, employees were
instructed to state that this information came from Medicare. When a senior
citizen agreed to the offer, employees would acquire patients’ Medicare
information. Patients would then be visited by a doctor, employed by Sharp, who
measured vital signs and prescribed home health care to all patients, whether or
not it was medically necessary.
Following
this, Sharp referred the Medicare patients to home health care agencies. She
allegedly offered to refer eighty patients and Medicare numbers each week in
exchange for a $250 fee per patient. In addition, Sharp claimed that the
doctors whom she employed would sign plans of care regardless of patients’
actual medical needs.
With
regard to the ramifications of this case, U.S. Attorney Terrence Berg stated
that “when Medicare is abused by unscrupulous persons to pay for unnecessary
treatment and to garner kickbacks, that conduct harms both legitimate Medicare
recipients as well as the program itself.”
There
is a federal law that prohibits illegal remuneration. This law is often called
the anti-kickback statute. It generally says that anyone who either offers to
give or actually gives anything to anyone in order to induce referrals has
engaged in illegal conduct. In this case, the payments allegedly made by home
health agencies to Continuing Senior Care seem to have been made in exchange for
referrals in direct violation of the anti-kickback statute.
In
addition, it is important for providers to note that if the referrals were
obtained illegally in violation of the anti-kickback statute and agencies
submitted claims for services provided to patients referred by Continuing Senior
Care, such claims may also violate the federal False Claims Act. The Office of
the Inspector General (OIG) of the U.S. Department of Health and Human Services,
the primary enforcer of fraud and abuse prohibitions, has clearly stated that
claims submitted for services provided to patients who were referred in
violation of applicable prohibitions are “false claims.” Submission of false
claims may also result in criminal prosecution and/or civil liability, amounting
to many thousands of dollars and suspension or exclusion from participation in
the Medicare and Medicaid Programs and other federal and state healthcare
programs.
In
addition to the necessity to avoid payment of kickbacks, therefore, providers
must be scrupulous about avoiding all illegal strategies for obtaining
referrals. When referrals are obtained by any unlawful means, the consequences
can be extremely significant for providers.
Consequently,
as part of the development of new marketing strategies, management must always
explore the legal boundaries of proposed methods of marketing prior to
implementation. In order to do so, marketing staff cannot be allowed to
implement new marketing programs without review and approval by management.
Review must include a thorough examination of whether the marketing program, as
proposed, violates applicable prohibitions and, if so, whether it can be changed
so that it passes muster.
(To
learn more about the above issues from a book titled Preventing Fraud and
Abuse, send a check for $30.00 that includes shipping and handling made out
to Elizabeth E. Hogue, Esq. to Fulfillment, 107 Guilford, Summerville, SC
29483. To obtain an 80-minute DVD that educates marketing staff and others
about fraud and abuse compliance, send a check for $105.00 that includes
shipping and handling to the above address.)
©Copyright, 2009.
Elizabeth E.
Hogue, Esq.
All rights
reserved. No portion of this material may be reproduced by any means without
the advance written permission of the author.
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