The Director of Social Services at a skilled nursing facility in California pled guilty to conspiring with the owners of home healthcare agencies to pay and receive illegal kickbacks in exchange for Medicare beneficiary referrals.
As the Director of Social Services, she assisted Medicare beneficiaries in selecting home healthcare agencies for services following their discharge from the facility. She used her position to steer residents and their families to the home health agencies that paid her illegal cash kickbacks for her referrals.
In a plea agreement, the Director of Social Services admitted that the home health agencies’ owners paid her kickbacks in exchange for the referral of approximately 100 beneficiaries. Medicare paid the agencies over $735,000 for services they purportedly provided to the beneficiaries. Since the agencies obtained the referrals by paying kickbacks, they should not have received any reimbursement from Medicare.
The Director of Social Services is scheduled to be sentenced in May 2021. She faces a maximum statutory penalty of five years in prison and a fine of $250,000 or twice the gross loss or gain. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which consider a number of variables.
Issue:
All members of the healthcare team must be aware of what may be considered an illegal kickback. Confirm that all staff are aware that a violation can be illegal, whether it is intentional or not intentional. A kickback, or failure to report a kickback, can result in fines and other sanctions, including placement on the OIG List of Excluded Individuals and Entities.
Discussion Points:
- Review your policy and procedure for preventing and reporting an anti-kickback statute violation. Update your policies and procedures as needed.
- Train all staff on the Anti-Kickback Statute and what can be considered a 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 employee’s education file.
- Periodically audit to ensure that staff are aware of what should be done if they suspect an illegal kickback has occurred, whether intentionally or unintentionally. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 2 Financial Integrity, CP 2.3 General Legal Duties and Antitrust Laws.
FRAUD MODULE 3 – MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS
