If illegal referral fees (or kickbacks) are proven, under the law, the entire claim becomes a "false claim" and makes the fraud easier for the government to prove. This is the case even when the services were provided.
In Houston, the owners, the director of nursing and patient recruiters of a home-health agency were arrested in November 2015 and the case is set for trial on May 9, 2016.
According to the indictment, Ebong Tilong and Marie Neba used the Texas-based, home-health agency that they owned to bill Medicare for home-health services that were allegedly not provided or not medically necessary. From in or around February 2006 to in or around June 2015, it is alleged the home health agency and its owners (Tilong and Neba) received approximately $13 million for these allegedly fictious or unnecessary home-health services.
According to the Indictment, the defendants allegedly paid kickbacks to a series of individuals. First, Tilong and Neba allegedly paid illegal kickbacks to physicians in exchange for authorizing medically unnecessary home-health services. Using the money that Medicare paid for such fraudulent claims, Tilong and Neba allegedly paid illegal kickbacks to Daisy Carter and Connie Ray Island in exchange for referring Medicare beneficiaries for home-health services.
Finally, all four defendants allegedly paid illegal kickbacks to Medicare beneficiaries, in exchange allowing Tilong and Neba to bill Medicare using their Medicare information for home-health services that were not medically necessary or not provided. The charges are conspiracy to defraud Medicare, to pay illegal healthcare kickbacks and to commit money laundering.
Falsification of medical records is what the government uses to prove fraudulent intent and that the services are not necessary. In this case, the government alleges that Neba, who also served as the company’s director of nursing, falsified medical records to make it appear that Medicare beneficiaries qualified for and received home-health services.
Home health care fraud cases have changed the business significantly. There will be a move to require Medicare patients to use HMO services and to rely on large chains rather than small providers who are harder to audit, tend to have a higher rate of audit issues and have trouble making repayment in the event of any alleged overpayments.
Posted by Tracy Green, Esq.
Office: 213-233-2261
Office: 213-233-2261
