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DOJ charges 30 in "patients for cash" health care fraud scheme

The Department of Justice (DOJ) recently charged 30 in a "patients for cash" health care fraud scheme. According to the indictment, a home health organization illegally paid doctors, nurses, and at least one social worker along with other medical professionals in violation of the Anti-Kickback Statute (AKS) for referral of patients to a home health organization.

What was the violation?

The government states the transition into a home health care facility needs to be based solely on the patients' medical needs. The use of kickbacks can shift these referrals to one based on financial motivation. Lawmakers have passed laws to help better ensure the patients' needs are at the forefront of the decision. Laws that include the AKS.

In this case, the government contends the home health organization violated the AKS. This law states it is illegal to "knowingly solicit, offer, or pay kickback, bribe, or rebate for furnishing services under a Federal health care program." The indictment states those employed with the home health agency would take physicians, nurses, office staff and other medical professionals out for elaborate meals and sporting events to encourage the referrals to their facility. If referrals began to decrease, the head of the hospice care facility would allegedly provide lavish gifts to entice medical professionals to increase their rate of referrals.

Many of the patients who were referred for services were insured by Medicare. As a result, the DOJ contends the referrals were in violation of the statute.

What are the penalties?

If the government can support the allegations and the accused physicians, nurses and medical professionals who partook in the alleged scam do not build a strong defense to the allegations, they could face up to 10 years imprisonment and $500,000 in fines. The man accused of leading the scam faces an additional 25 years imprisonment and $500,000 in fines.

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