Florida is one of the top retirement havens in the United States. Accordingly, it is one of just a handful of areas specifically targeted by Medicare fraud task forces, as the potential for scams and misconduct is congruently heightened by the increasing elderly population.
In today’s post, we review a recent settlement involving South Florida’s Hebrew Homes Health Network, which maintains skilled nursing facilities in a number of U.S. states.[1. McCue, Dan, “Fla. Nursing Home to Pay $17M to Settle DOJ Case.” June 16, 2015. http://www.courthousenews.com/2015/06/16/fla-nursing-home-to-pay-17m-to-settle-doj-case.htm] According to a whistleblower complaint, the facility is alleged to have engaged in Medicare fraud and unlawful billing practices for a period spanning from 2006 through 2013.
Medicare fraud officials are pleased to have resolved the matter, but understand there are likely dozens – if not hundreds – more like it lurking within the healthcare industry. The case was originally brought to light by the former Chief Financial Officer of Hebrew Homes, who is expected to receive $4.25 million in exchange for his willingness to expose the fraud.
Details of the alleged misconduct within Hebrew Homes
Employing one of the most common schemes punishable by the False Claims Act, Hebrew Homes is alleged to have enticed doctors and specialists in the surrounding South Florida area to refer as many Medicare patients as possible to its facilities. In exchange for the referrals, Hebrew Homes promised the doctors lucrative financial rewards, which were shrouded under the guise of sham “medical director” and consultant positions.
Described by the Department of Justice as a “sophisticated kickback scheme,” Hebrew Homes engaged in a contractual relationship with several doctors wherein the doctors would serve as “medical directors” within the facilities.[2. Department of Justice Press Release, “Florida Skilled Nursing Facility Agrees to Pay $17 Million to Resolve False Claims Act Allegations.” June 16, 2015. http://www.justice.gov/opa/pr/florida-skilled-nursing-facility-agrees-pay-17-million-resolve-false-claims-act-allegations] The contracts were well-drafted to include work hours, hourly rate, and various other terms and conditions in an attempt to appear legitimate. Upon further investigation, however, the positions were found to be “ghost” jobs without any actual responsibilities. Instead, the doctors performed few, if any, actual tasks required by the contract – yet they were paid handsomely so long as Medicare referrals were continually admitted to the facilities.
In addition to a $17 million settlement, the director and CEO of Hebrew Homes has agreed to step down. The company has also agreed to enter into a 5-year corporate integrity agreement and must revamp its hiring and oversight procedures.
Medicare task force continues to combat fraud
Described by one outlet as “ground zero” of Medicare fraud, Florida continues to combat the plague of scams tormenting the senior citizen mecca, particularly focusing on Miami-Dade counties and nearby areas of the Southeastern sector of the state.[3. Parker, Chris, “South Florida Is Ground Zero for Medicare Fraud.” May 2, 2013. http://www.miaminewtimes.com/news/south-florida-is-ground-zero-for-medicare-fraud-6391954]
The U.S. Attorney’s Office said in a statement, “The record settlement announced today demonstrates this office’s commitment to rooting out all forms of illegal kickback schemes….And that is certainly true in the context of nursing homes, where the Department of Justice will not allow healthcare decisions for elderly Medicare patients to be influenced by kickback payments to physicians. The integrity of our public health care program requires that such decisions be based on quality of care.”
Likewise, the Department of Health and Human Services commented, stating “Hebrew Homes’ intricate kickback scheme in this record-setting case threatened the impartiality of physician referrals, the financial integrity of Medicare, and the public’s trust in the healthcare system….Our agency will continue to investigate nursing homes and other healthcare providers that seek to illegally boost profits at the expense of federal healthcare programs.”
Contact Berger Montague for more information today
If you are considering a healthcare fraud whistleblower claim, please do not hesitate to contact Berger Montague for a confidential consultation today!