Paying for Referrals – Not in Healthcare You Don’t
Kimberly Shutters, CPC-A, CAPM, CPCO
Medical Coder | Revenue Cycle Management | Healthcare Compliance Officer
Case Study: Forest Park Medical Center
Paying for referrals, in some industries, is acceptable to reward those who refer business to you. But as you know, healthcare is not like most businesses. Paying for referrals is a violation of the federal Anti-Kickback Statute.
On March 19, 2021, fourteen defendants in the Forest Park Medical Center (FPMC) bribery scam found that out the hard way. They received a combined sentence of 74+ Years in federal prison and were ordered to pay a total of $82.9 million in restitution. In addition to the $82.9 million restitution, the government plans to collect more than $25.5 million in money judgments against those convicted.
Before I dive into the sentencing phase of this case, I believe it adds value to learn about the details of what the inditement exposed.
The Inditement
On December 1, 2016, twenty-one defendants from FPMC were charged with various felony offenses stemming from their payment and/or receipt of approximately $40 million in bribes and kickbacks for referring certain patients to FPMC. Each of the 21 defendants is charged with one count of conspiracy to pay and receive health care bribes and kickbacks; the maximum statutory penalty upon conviction is five years in federal prison and a $250,000 fine.
According to the indictment, the referred patients were primarily ones with high reimbursing out-of-network private insurance benefits or benefits under certain federally funded programs. FPMC’s owners, managers, and employees also attempted to sell patients with lower reimbursing insurance coverage, namely unwitting Medicare, and Medicaid beneficiaries, to other facilities in exchange for cash. As a result of the bribes, kickbacks, and other inducements, from 2009 to 2013, FPMC billed such patients’ insurance plans and programs well over half of a billion dollars and collected over $200 million in paid claims.
Oh, What A Tangled Web We Weave
Sir Walter Scott said it well:
“Oh, what a tangled web we weave, when first we practice to deceive.”
I find that quote is extremely appropriate, and I believe you will too as you uncover the details behind this case.
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3 年It’s amazing Kimberly that these type of things go on but as we know they do. So glad there are more audits and cross checks starting to take care of this.