Healthcare Compliance Perspective:
Physicians, employees, diagnostic testing facilities, and various other healthcare providers are strictly prohibited from accepting gifts, favors, payments, services, or anything else of value which might appear to influence the actions of the physician or the facility. The Anti-Kickback Statute prohibits extending or receiving remunerations in exchange for referrals.
Owners in three Brooklyn independent diagnostic testing facilities have been indicted on 14-counts for their roles in an alleged fraudulent scheme. Their scheme involved the submission of over $44 million in claims to Medicare and private insurers. The scheme also included government-sponsored managed care organizations; and, it is estimated that the three were paid at least $19 million on those claims.
The three defendants were each charged with one count of health care fraud, two counts of making false claims to a federal agency and one count of conspiracy to pay health care kickbacks. Two of the defendants were also charged with one count of conspiracy to defraud the United States by obstructing the lawful functions of the IRS, and one of them was charged with two counts of making false statements to federal agents.
The period cited in the indictment was from January 2014 through at least December 2016 and involved the submission of fraudulent claims to Medicare, Medicaid managed care plans and other health care benefit programs for diagnostic testing services. The defendants allegedly paid kickbacks for the referral of beneficiaries who submitted themselves for diagnostic testing and other supposed medical services. The beneficiaries allegedly also received kickbacks and caused the submission of fraudulent claims to be submitted.
The defendants disguised their illicit payments by using shell companies to move the financial transactions in amounts greater than $10,000 and make them appear to authorities as legitimate business expenses. This resulted in the defendants under-reporting business income and claiming illegal deductions to the IRS.
