Thursday, February 18, 2016

Florida Health Care Clinic "Consultant" and Biller Pleads Guilty in Marketing Partial Hospitalization Program And Directing Payments to Patient Brokers in Exchange for Patient Referrals

In the past, aggressive health care entities would seek to avoid the limits of federal and state anti-kickback statutes and federal STARK laws by creating consulting, marketing and outreach agreements that appeared on their face to be compliant. 

Federal investigations are filing health care fraud cases based on the marketing arrangements that when reviewed reveal payments for the referral of patients with essentially no other "marketing" or services performed. 

When the marketing entities are investigated, they tend to show cashed checks, payments to others for referral of patients, and other evidence of payments for patients. Legal marketing payments are not supposed to include payments for the referral of patients.

A recent case shows that the government is being aggressive on illegal marketing arrangements.  Nery Cowan, a former Miami health care clinic consultant and Medicare biller, pleaded guilty on January 14, 2016 in connection with her marketing role for a defunct Miami-area health care provider. She pleaded guilty before U.S. District Judge Beth Bloom of the Southern District of Florida to one count of conspiracy to commit money laundering. Ms. Cowan will be sentenced by Judge Bloom on March 25, 2016.  

According to the factual basis, Ms. Cowan served as a consultant and Medicare biller for Greater Miami Behavioral Healthcare Center Inc. (Greater Miami), a partial hospitalization program (PHP) that purported to provide intensive treatment for severe mental illness. According to court documents, from 2006 through 2014, Greater Miami billed Medicare approximately $63 million for purported mental health services.

Ms. Cowan was involved in directing the payment of kickbacks to patient brokers and others in exchange for Medicare beneficiary referrals. Ms. Cowan admitted that she received a percentage of the Medicare reimbursement from Greater Miami’s PHP as compensation. This means that getting the percentage as a biller could be problematic when there is illegal referral fees being paid.

Ms. Cowan admitted that she, along with co-defendants Dean Butler and Irina Mora, took great lengths to conceal kickback payments to shell companies owned by “patient brokers” who, on behalf of Greater Miami, solicited Medicare beneficiaries from assisted living facilities, halfway houses and drug courts located throughout the Southern District of Florida.  

Ms. Cowan admitted that she, Butler and Mora disguised these monthly kickbacks as “outreach” or “marketing” payments through HNB-Stell Care Inc., a sham staffing company. On Nov. 30, 2015, Judge Bloom sentenced Mr. Butler to 16 years in prison and Ms. Mora to nine years in prison following their guilty pleas.

Posted by Tracy Green, Esq.


DISCLAIMER: Green & Associates' articles and blog postings are prepared as a service to the public and are not intended to grant rights or impose obligations. Nothing in this website should be construed as legal advice. Green & Associates' articles and blog postings may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents and contact their attorney for legal advice. The primary purpose of this website is not the commercial advertisement or promotion of a commercial product or service and this website is not an advertisement or solicitation. Anyone viewing this web site in a state where the web site fails to comply with all laws and ethical rules of that state, should disregard this web site.

The information provided on this website is for informational purposes only. It is not intended to create, and does not create, a lawyer-client relationship with Green & Associates, Attorneys at Law. Sending an e-mail to Tracy Green does not contractually obligate them to represent you as your lawyer, or create any type of client relationship. No attorney-client relationship will be formed absent a written engagement or retainer letter agreement signed by both Green & Associates and client and which specifies the scope of the engagement.

Please note that e-mail transmission is not secure unless it is encrypted. E-mail messages sent to Ms. Green should not include confidential or sensitive information.