According to an announcement from the United States Department of Justice (DOJ) on October 12, 2021, a Louisiana physician has agreed to pay the United States $640,000 to resolve allegations that he accepted payments for referrals of home health patients. The allegations are violations of the Anti-kickback Statute.
The physician was the medical director for a home health agency that is no longer in existence. In that role, he received monthly payments. The United States alleges that his fees exceeded the fair market value for his services and that the excessive fees included payment for referrals of patients, many of whom were Medicare beneficiaries.
The Anti-kickback Statute was passed in Congress to prevent financial incentives from improperly influencing medical decision-making, which can lead to excessive and unnecessary services. Specifically, the Anti-kickback Statute prohibits offering or paying anything of value to induce the referral of items or services covered by federal health care programs.
Acting United States Attorney Alexander C. Hook stated, “Improper financial relationships between health care providers can lead to overutilization and increase the cost of health care services paid for by the taxpayers. We will continue to ensure that health care decisions are based on the needs of patients rather than the financial interests of providers.”
Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement of government funds can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
Issue
The focus of a Compliance and Ethics Program should be on protecting government funds from fraud, waste, and abuse and detecting criminal, civil, and administrative violations while promoting quality of care. The Centers for Medicare & Medicaid Services (CMS) requires skilled nursing facilities to have a Compliance and Ethics Program that is effective in this effort. The Compliance and Ethics Committee, when operating appropriately, will assist in detecting false claims, illegal kickbacks, HIPAA breaches, and other violations. It is imperative that every facility have an effective Compliance and Ethics Officer and Committee to reduce the likelihood of healthcare fraud, waste, and abuse of government funds. More information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 1, Compliance and Ethics Program.
Discussion Points:
- Review your policies and procedures for operating an effective Compliance and Ethics Program. In addition, review your policy and procedure for preventing and reporting a false claim or anti-kickback statute violation. Update your policies and procedures as needed.
- Train all staff on your compliance and ethics policies and procedures upon hire and at least annually thereafter. Also, 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 these trainings occurred and file the signed document in each employee’s 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. Also, periodically perform audits to ensure all are aware of compliance and ethics concerns and are knowledgeable of how they can report any concerns or violations.
