Anecdotally, for years the home care industry has been rife with rumors that discharge planners/case managers in hospitals and SNFs were accepting kickbacks in exchange for referrals. Fraud enforcers are now targeting discharge planners/case managers for enforcement action.
Most recently, a Registered Nurse (RN) in California pled guilty to conspiring with owners of home health agencies to pay and receive illegal kickbacks in exchange for referrals of Medicare patients. The RN, who was a case manager at a nonprofit hospital, used his position as a discharge planner to steer Medicare patients to home health agencies who paid kickbacks to him.
In a previous article, we discussed federal Criminal Complaints that have been filed against thirty defendants in the San Francisco area who are charged in a “patients-for-cash” kickback scheme. The complaints center on Amity Home Health Care, the largest home health care provider in the Bay Area, and Advent Care, Inc., a hospice. Under the leadership of Ridhima “Amanda” Singh, Chief Executive Officer, the federal government claims that Amity and Advent paid kickbacks to discharge planners/case managers at hospitals and social workers at skilled nursing facilities (SNFs), among others, in exchange for referrals.
The Criminal Complaints say that discharge planners/case managers in hospitals and SNFs received the following in exchange of referrals of home health and hospice patients:
These alleged payments and gifts clearly violate the federal anti-kickback statute. The anti-kickback statute generally prohibits anyone from either offering to give or actually giving anything to anyone in order to induce referrals.
If convicted, all parties involved may be subject to imprisonment for up to ten years and fines of $500,000. So, ask yourself: Is the color orange a fashion statement I would like to make? The answer is surely a resounding “No!”
These cases make it quite clear that marketers for home health companies and discharge planners/case managers must just say, “NO!” The “jig is up,” as they say. Marketers and discharge planners/case managers, you have been discovered! Enforcers now know, if they didn’t know before, that there are discharge planners/case managers who accept payments and other items in exchange for referrals and marketers who provide them. Case managers/discharge planners and marketers can certainly expect more enforcement actions against them in the near future.