Louisiana Man Pleads Guilty for His Role in Scheme to Defraud Medicare by Soliciting Kickback Payments for Two Physicians
A Louisiana man pleaded guilty recently to soliciting payment of illegal healthcare kickbacks and bribes to several individuals, including two physicians. The kickbacks and bribes were paid so the physicians would refer and certify Medicare recipients for medically unnecessary home health services provided by the facility owned by one of the co-conspirators.
The defendant admitted that he participated in the scheme with two co-defendants, a patient recruiter, clinic owner, and others. He also admitted to soliciting approximately $331,000 in kickbacks disguised as marketing fees and to monthly kickbacks of $1,500 for so-called medical director fees.
Sentencing for the defendant is set for August 22, and the two physicians, who pled guilty earlier this year, are awaiting sentencing in July and August. The clinic owner pleaded guilty in 2017 and will be sentenced in July. A jury found the patient recruiter guilty after a three-day trial in 2017 and he was sentenced to 51 months in prison in January 2018.
Compliance Perspective
Paying kickbacks and bribes to healthcare providers, e.g., hospitals, doctors, etc., to provide referrals and certifications of Medicare recipients for healthcare services violates state and federal anti-kickback laws.
Discussion Points:
- Review policies and procedures regarding paying or receiving kickbacks or bribes to/from physicians, or staff members.
- Train staff on the facility’s policies and procedures prohibiting receipt or payment of bribes and kickbacks.
- Periodically audit to determine if residents are qualified for Medicare or were referred to the facility due to possible bribes and kickback payments.
FRAUD MODULE 3- MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS
