An Ohio federal grand jury has returned a twenty-four-count indictment charging four individuals for their roles in healthcare fraud conspiracy that resulted in more than $20 million in false claims to the Medicare program.
In addition to the healthcare fraud conspiracy charges, two of the defendants are also charged with making false statements relating to healthcare matters. Two of the defendants are also charged with additional counts of healthcare fraud and the offering and payment of kickbacks in connection with a federal healthcare program.
One of the defendants owned and operated a medical marketing company and a durable medical equipment company in Ohio. Another defendant owned and operated separate durable medical equipment companies, also located in Ohio. The other two defendants were nurse practitioners who are licensed and certified by the State of Ohio.
According to the indictment, from March 2018 to September 2019, the defendants are accused of conspiring together to defraud Medicare by obtaining payment for unnecessary medical claims. The two nurse practitioners, while working for telemedicine companies, are accused of signing prescriptions for medical braces, regardless of medical necessity, without a physical examination and frequently without any contact with the beneficiary whatsoever.
It is alleged that these telemedicine companies would then transfer the prescriptions to medical marketing companies, including one owned by one of the defendants, who would then use them as part of an unlawful package of Medicare beneficiary leads sold to durable medical equipment companies. The defendant and others are accused of providing bribes and kickbacks to the other defendants medical marketing company, in exchange for the leads packages, which they would then use to arrange for the ordering of the medical braces for beneficiaries.
If convicted, the defendantsā sentences will be determined by the Court after review of factors unique to this case, including the defendantās prior criminal record, if any; the defendantās role in the offense, and the characteristics of the violation. The investigation was conducted through joint efforts of the Federal Bureau of Investigation (FBI); the Department of Health and Human Services (HHS); and the Office of Inspector General (OIG).
Issue:
It is extremely important that all members of the healthcare team are 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 not intentional. Failure to promptly report a false claim or kickback can result in civil or criminal charges, 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 employeeās education file.
- Periodically audit staff understanding 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.
FRAUD MODULE 3 – MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS
