Federal Authorities Working to Stop Medicare Kickback Schemes Involving Patient Recruiters and Home Healthcare Company Owners
A federal jury in Michigan recently found a patient recruiter guilty in a scheme that involved about $1.3 million in fraudulent Medicare claims for home health services that were acquired through kickback payments. Evidence during the trial showed that the defendant solicited and received kickbacks in exchange for referring Medicare beneficiaries to serve as patients at multiple home health agencies. The home health agencies in turn submitted claims to Medicare for home health services that supposedly were provided to those beneficiaries.
Earlier this year the government was successful in breaking-up several other Medicare kickback schemes where patient recruiters and home healthcare providers participated in fraudulent Medicare schemes totaling over $12 million.
One of those schemes involved two defendants, a home healthcare services company owner and a co-conspirator. Both defendants pleaded guilty and received prison sentences. The owner admitted to paying kickbacks and bribes to commit healthcare fraud by billing Medicare for physical therapy services performed by the unlicensed co-conspirator.
According to the Department of Justice (DOJ), in just this one case, Medicare paid $8.6 million in fraudulent claims.
Compliance Perspective
Soliciting and receiving kickbacks from healthcare agencies in exchange for referrals of Medicare beneficiaries to serve as patients at those agencies, then fraudulently billing Medicare for services provided by unlicensed personnel, is a violation of federal regulations.
Discussion Points:
- Review policies and procedures regarding kickbacks and using appropriately licensed physical therapy staff to provide services.
- Train staff involved in the claims reimbursement process to be alert for and report suspected instances of claims being submitted for services that were not provided or that were provided by unlicensed personnel.
- Periodically audit to verify that the Medicare beneficiaries whose information is used in billing Medicare for reimbursement of services are actually provided necessary services by authorized individuals.
