Discharge Planners/Case Managers: What Would Patients and Their Families Think?

Case managers/discharge planners continue to come under fire from fraud enforcers for violations of the federal anti-kickback statute.? This statute generally prohibits anyone from either offering to give or actually giving anything to anyone in order to induce referrals.? Case managers/discharge planners who violate the anti-kickback statute may be subject to criminal prosecution, which could, among other consequences, result in prison sentences.

Many post-acute providers have heard about Louis Vuitton handbags, cars, trips to Napa Valley or other luxury destinations, etc. given to discharge planners/case managers. They’ve seen case managers/discharge planners with thick stacks of gift cards received from post-acute providers.

Here is what a representative of the Justice Department said about kickbacks in a recent press release:

“Whether you pay them or receive them, kickbacks undermine the integrity of our health care system.? Patients need to know that health care referrals they receive are in their best interest, not in the best interest of someone else’s bottom line.? Our office will always be on guard to prevent unscrupulous operators from trying to take financial advantage of our health care systems.”

Key questions for discharge planners/case managers must be: What would patients and their families think if they knew about the gifts we receive from post-acute providers?? What would patients and their families think if they knew that the expensive handbag I’m carrying today came from the post-acute provider to which I referred the patient?

Case managers/discharge planners have gotten a “pass” from fraud enforcers for many years.? Time is up!

Recently, for example, a U.S. District Judge in California sentenced an owner of a post-acute provider to eighteen months in prison for one count of conspiracy to commit health care fraud, and one count of conspiracy to pay and receive health care kickbacks.? From July of 2015 through April of 2019 the provider paid and directed others to pay kickbacks to multiple case managers/discharge planners for referrals of Medicare patients, including employees of health care facilities and employees’ spouses.? Recipients of the kickbacks included a discharge planner/case manager at a hospital, and discharge planners at skilled nursing and assisted living facilities.

Payments of kickbacks resulted in over eight thousand claims to Medicare for patients referred to the provider.? Medicare paid the provider at least two million dollars for services provided to patients referred in exchange for kickbacks.? Because the provider obtained patient referrals by paying kickbacks, the provider should not have received any Medicare reimbursement.? The discharge planners/case managers who received kickbacks from the provider also pled guilty and will be sentenced soon.

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), the primary enforcer of fraud and abuse prohibitions, says that discharge planners/case managers and social workers cannot accept the following from providers who want referrals:

• Cash
• Cash equivalents, such as gift cards or gift certificates
• Non-cash items of more than nominal value
• Free discharge planning services that case managers/discharge planners and social workers are obligated to provide

Discharge planners/case managers and social workers provide extremely important services that are valued by many patients and their families, but their credibility and trustworthiness is destroyed when they make referrals based on kickbacks received.

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?2023 Elizabeth E. Hogue, Esq.? All rights reserved.

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