June 28, 2013
Billing Medicaid for Services Provided as Part of a Kickback Scheme Violates the False Claims Act
June 28, 2013 — Since the Anti-Kickback Statute was amended in 2010, violations of this rule automatically breach the federal False Claims Act. The qui tam language of the Act allows health care employees who discover illegal kickback scams to file suit against unethical health care providers on the government’s behalf. Tipsters retain a share of the government’s financial recovery. Anyone with unique information about kickbacks or false claims may bring a whistleblower lawsuit, but insider employees are frequently the best situated to discover violations and notify the government.
Eugene Goldman, M.D., a physician in Pennsylvania, has been convicted in federal court for his part in an illegal kickback operation during the doctor’s employment with Home Care Hospice Inc. (HCH) as the medical director. Between December 2000 and July 2011, Goldman routinely referred Medicaid and Medicare beneficiaries to HCH, a for-profit Philadelphia hospice provider for patients at hospitals, nursing homes, and private residences.
In a December 2000 written contract, Goldman and an HCH co-owner agreed to create the appearance that any payments by HCH to Goldman were for Goldman’s services as HCH’s medical director though in reality most of the HCH payments to Goldman were nothing more than unlawful compensation for his referral of Medicaid and Medicare beneficiaries to the hospice provider. Between January 2003 and October 2008, HCH paid Goldman around $263,000 in kickbacks. In 2009, the physician was caught on videotape as he received the illicit payments.
At sentencing, Goldman could receive a substantial prison sentence. He could also lose his license to practice medicine. In addition, Goldman will be prevented from participating in any federal healthcare program in the future.
It is well known in the health care field that it is illegal for a health care provider to pay a physician to refer patients to the provider. Still, it can be very difficult to collaborate with the government when a co-worker or supervisor is paying or receiving kickbacks. Informants who notify the Justice Department about illegal kickbacks deserve to understand their own legal rights from the beginning. The whistleblower lawyers with Waters & Kraus offer tipsters the experienced legal counsel they can rely on. Contact us by email or call our qui tam attorneys at 855.784.0268 to learn how we can protect your interests.
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