Creative Medicare Fraud Scheme Gets Busted in South Florida

The scheme at issue in today’s post may get points for creativity, but it wasn’t enough to evade the healthcare fraud task force charged with punishing and deterring wasteful and illegal misconduct. In today’s case, we discuss a recent settlement involving two South Florida healthcare practitioners and their wives accused of accepting unlawful kickbacks for home healthcare referrals.

As you know, any submission for reimbursement to programs like Medicare and Medicaid tainted by the impropriety of a kickback or financial incentive will be subject to liability under the False Claims Act. Under the Act, a practitioner can face up to triple damages that can quickly amount to a major payout, even for the most successful doctor or hospital.

Details of the case involving South Florida’s home healthcare industry

Historically, the state of Florida is known as a top retirement destination for East Coasters, particularly those beleaguered with years of snowstorms and unrelenting winter weather. As such, Florida is heavily populated with senior citizens driving a marketplace saturated with home healthcare providers. The case against A Plus Home Health Care, Inc. indicate that the South Florida care provider devised a kickback scheme to induce physicians to refer more patients to its services by targeting doctors’ spouses.

According to the allegations, A Plus contacted several doctors’ wives and offered them positions as “marketing consultants,” promising generous salaries with little actual work. In fact, the work required was so minimal that healthcare fraud investigators concluded that the arrangement was simply a veiled disguise for a kickback scheme. In other words, it was a complete sham. According to reports, the wives were not actually required to perform any work under the employment agreements.

The settlement involved two couples targeted by A Plus but five other South Florida doctors and their spouses previously settled with the government for accepting A Plus’s attempts to induce patient referrals.

A former employee of A Plus brought the allegations to light and exposed the fraud and patient endangerment caused by the illegal use of kickbacks to procure Medicare and Medicaid patients. The details of his whistleblower reward have not been disclosed publicly at this time.

Government’s response to the scam

In a statement by the Department of Health and Human Services, the government noted, “Being a physician in the Medicare program is a privilege, not a right… Physicians who engage in such in-your-face kickback schemes to refer Medicare patients to certain home health companies in exchange for money will be held accountable for their behavior. Our agency will continue to crack down on kickbacks, which undermine impartial medical judgment, corrode the public’s trust in the health care system and waste scarce Medicare funding.”

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