A California home healthcare and hospice agencies’ owner was sentenced to 18 months in prison for one count of conspiracy to commit healthcare fraud and one count of conspiracy to pay and receive healthcare kickbacks. According to court documents, the woman and her husband owned and controlled home healthcare and hospice agencies in the greater Sacramento area. On behalf of the agencies, they certified to Medicare that they would not pay kickbacks in exchange for Medicare beneficiary referrals to the agencies.
Despite their certifications, from at least July 2015 through April 2019, the couple paid and directed others to pay kickbacks to multiple individuals for beneficiary referrals, including employees of healthcare facilities, as well as employees’ spouses. The kickback recipients included a registered nurse who worked for a hospital in Sacramento; the director of social services at a skilled nursing and assisted living facility in Sacramento, and her husband; and the director of social services at a skilled nursing facility in Roseville.
In total, the agencies submitted over 8,000 claims to Medicare for the cost of home healthcare and hospice services. Based on those claims, Medicare paid the agencies approximately $31 million. Of that amount, Medicare paid the agencies at least $2 million for services purportedly provided to beneficiaries referred in exchange for kickbacks paid to, among others, those mentioned above. Because the agencies obtained the beneficiary referrals by paying kickbacks, the agencies should not have received any Medicare reimbursement.
Issue:
Under federal and state Anti-kickback Statutes, you may not knowingly and willfully offer, pay, solicit, or receive anything of value to induce or reward for referrals of federal or state healthcare program business. The prohibition against kickbacks applies to those who pay for referrals and to those who receive them. Kickbacks can take various forms, such as bribes or rebates. They can be given in cash or in kind. Failure to promptly report a kickback can result in lawsuits, fines, and other sanctions.
Discussion Points:
- Review policies and procedures for preventing and reporting an anti-kickback violation. Update your policies and procedures as needed.
- Train all staff on federal and state anti-kickback statutes and what can be considered a kickback. Include information on how to report concerns and suspected violations, and make sure staff know that prompt reporting is mandatory. Document that the trainings occurred and place in each employee’s education file.
- Periodically audit staff understanding to ensure that they are aware of what should be done if they suspect an 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.
