Owner of Michigan Home Health Agency Sentenced for Role in $1.5 Million Medicare Kickback Scheme
The owner of a Michigan home health agency was recently sentenced to five years in prison for his role in a scheme involving approximately $1.5 million in Medicare claims for home health services that were procured through the payment of illegal kickbacks. The defendant pleaded guilty to one count of conspiracy to defraud the United States by paying and receiving healthcare kickbacks in connection with a federal healthcare program and four counts of paying healthcare kickbacks.
As part of his guilty plea, the owner admitted that he paid illegal kickbacks to recruiters in exchange for Medicare beneficiary referrals and billed Medicare for claims procured through these illegal kickbacks. According to court documents, the defendantās scheme cost the Medicare program over $1 million in fraudulently submitted claims from 2013 through 2017. The claims were related to Medicare beneficiary information obtained by paying illegal kickbacks.
Along with the five-year prison sentence, the U.S. District Judge ordered the defendant to pay about $1 million in restitution together and separately with his co-conspirators.
Compliance Perspective
Paying and receiving kickbacks in exchange for Medicare beneficiary referrals and then using that Medicare beneficiary information to submit fraudulent claims may be considered a violation of the federal Anti-Kickback Statute and submission of fraudulent claims in violation of the False Claims Act.
Discussion Points:
- Review policies and procedures regarding federal laws prohibiting paying and receiving kickbacks and using illegally obtained Medicare beneficiariesā information to submit false claims.
- Train staff about the policies and procedures prohibiting kickbacks or submission of claims based on illegally obtained Medicare beneficiariesā information. Advise staff to be alert to any suspected incident involving the paying or receiving of kickbacks or submission of false claims and the necessity of reporting such incidents immediately to their supervisor or through the Hotline.
- Periodically audit submitted claims to verify that those Medicare beneficiaries actually received the services.
FRAUD MODULE 3 – MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS
