The owner of a South Florida clinic arranged a scheme through which he received kickbacks of approximately $1300 per Medicare beneficiary from patient recruiters and home health agencies in return for having a physician write prescriptions, plans of care and medical certifications for unnecessary home healthcare and therapy services for Medicare beneficiaries.
The home health nurses, as a part of the scheme, falsified patient records to make it appear that the Medicare beneficiaries qualified for two to three skilled nursing visits per day. The Medicare beneficiaries did not need or qualify for the home health services. The nurses also received kickbacks for the Medicare patients they recruited for the home health agencies, even though they knew the patients did not qualify for the home health services. The nurses admitted that they created the false documentation so the Medicare program could be billed for the medically unnecessary services.
According to trial testimony, one of the nurses also paid kickbacks in return for ensuring that she would be assigned by the home health agencies as the nurse for the beneficiaries involved in the recruitment scheme. In many instances, the nurse did not provide any services to the assigned patients.
The nurses were convicted of conspiracy to commit healthcare fraud and sentenced to prison terms ranging from five months to 30 months for their roles. The convictions of these nurses should serve as a prime example of how important it is for nurses to assure that their documentation is accurate and to be aware they can be convicted even if they submit no claims or documentation to CMS themselves.