iMarch 15, 2022. A Florida man orchestrating home healthcare patient recruiting scheme pled guilty to one count of conspiracy to commit healthcare fraud for receiving bribes and kickbacks in exchange for Medicare beneficiary referrals. This fraud scheme garnered $870,000 in false claims from Medicare, of which the patient recruiter pocketed $630,000. A whistleblower at the five home healthcare companies involved could have spotted this paying-for-patients scheme and reported the fraud against government health programs.
According to the allegations, the Miami, Florida patient recruiter and co-conspirators tapped Medicare beneficiaries to apply for home healthcare services. In order to ensure the beneficiaries received services, the co-conspirators told the prospective patients what to say in order to obtain a prescription. Five home healthcare agencies were involved in this scheme over a period of five and a half years. The recruiter paid kickbacks to Medicare beneficiaries, while also receiving kickbacks and bribes from the home healthcare companies. The home healthcare agencies billed Medicare for services that were neither medically necessary nor actually provided. The recruiter hid their ill-gotten gains in shell companies. For pleading guilty to one count of healthcare fraud, the recruiter faces up to 10 years in prison.
Medicare Parts A (hospital insurance) and B (medical insurance) cover home healthcare services, provided that a doctor certifies that a beneficiary needs these services and is in fact homebound. Bilking the system to earn payments for services not rendered diminishes Medicare’s capacity to provide these services for patients with actual need.
An employee of the home healthcare companies could have reported this fraud to the government. After reporting Medicare fraud, a whistleblower may receive 15-25% of funds recovered by the government in a successful qui tam lawsuit. Whistleblowing protects taxpayer funds and the integrity of government-funded healthcare programs such as Medicare.
