“Can’t take payment kickbacks because you’re a ‘doctor’? That’s okay, we’ll just pay your spouse instead.” This has been the mantra of A Plus Home Health Care, Inc. since 2006. The Department of Justice (DOJ) has intervened in a lawsuit against the company for providing kickbacks to physicians through their spouses in exchange for referring patients to their facilities.
“The practice of physicians receiving kickbacks for patient referrals undermines the trust a patient has that his or her physician is placing the patient’s care above their own personal interests,” commented Christopher Paulos, an attorney with the Levin, Papantonio law firm who practices in the areas of whistleblower or qui tam litigation.
The whistleblower lawsuit was started by former A Plus Home Healthcare director, William Guthrie. According to the qui tam provision of the False Claims Act, Mr. Guthrie could bring suit against A Plus on the government’s behalf. The government has the option to intervene in a suit to pursue recovery.
“Whistleblowers offer a vital service to the public in battling corruption and fraud,” Mr. Paulos added.
To try and hide the kickback scheme, the government alleges, A Plus created salaried positions for the spouses and significant others of physicians. This practice included creating sham employment files, faked reviews, and job tasks that the employees never actually performed. According the the DOJ’s release, after A Plus began this practice, it saw a large spike in the number of referrals it received from outside physicians.
To mark the dramatic effect that the kickback scheme had on A Plus’s Medicare billings, the Justice Department referenced that, in 2005, before the beginning of the kickback scheme, the company received $1.1 million from Medicare for its services. In 2006, after beginning the kickback scheme, the company received $6.6 million in reimbursements from Medicare for its services.
Guthrie’s suit is another in the ongoing battle the government is fighting against healthcare fraud as part of its Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative. If the government is successful in recovering in the case, Mr. Guthrie could share in between 15 and 30 percent of the total amount recovered.
“The incentives provided by the False Claims Act encourage whistleblowers to come forward with their specific knowledge of fraudulent practices against the government,” Mr. Paulos commented. “The monetary reward is an effort on the part of the government to thank these brave individuals for coming forward and helping protect American taxpayers.”