Fraud and Abuse Spotlight: Florida and North Texas.
The heightened enforcement of fraud and abuse and anti-kickback continued in July with the spotlight shining on both Florida and North Texas.
In Florida, two Federal enforcement actions involved marketers in the home health care industry. In the first case, Healthquest, Inc. and its owners agreed to settle allegations that Healthquest paid kickbacks to marketers in order to induce patient referrals. Most interesting, the lawsuit was filed as a qui tam, or whistleblower, suit by a former Healthquest marketer. In the second case, a marketer for a home health agency pled guilty to health care fraud after she falsified documents and created fake referrals for patients to receive medically unnecessary home health services.
Both enforcement actions demonstrate the significant anti-kickback risks involved with marketing arrangements. Marketing arrangements are inherently suspect and must be structured appropriately to avoid running afoul of the Anti-Kickback statute. If not structured, properly there is risk that someone, even one within the organization and participating in the scheme, can sound the alarm to governmental agencies. Even if structured properly, there is the possibility that a marketer blinded by potentially lucrative compensation commits fraudulent or impermissible acts, which could create significant regulatory and criminal issues for all involved.
Closer to home here in North Texas, there was another development in the health care fraud case involving Forest Park Medical Center. Forest Park co-founder Alan Beauchamp agreed to plead guilty and admitted to recruiting high-volume specialty doctors and paying those doctors bribes and kickbacks to perform their surgeries at Forest Park. Mr. Beauchamp will be another witness and critical piece against the remaining defendants as the case nears its trial date later this year. In addition, once again North Texas was the sight of a Federal Bureau of Investigation (FBI) raid. Next Health, an owner of multiple laboratories and pharmacies currently facing fraud allegations from United Healthcare, and Critical Health Care Management, had their offices raided by the FBI as part of an investigation as to whether Next Health paid kickbacks to doctors for referring patients to its pharmacies, as well as other issues. This is just the latest example of governmental agencies cracking down on fraud and abuse with a focus on the North Texas area.
For more information on healthcare regulatory compliance, please feel free to contact Jay D. Reyero (firstname.lastname@example.org).