Friday, February 14, 2020

Sacramento Man Pleads Guilty to Medicare Kickback Scheme Involving Hospices and Home Health Agencies



Home health agencies are routinely investigated for kickbacks and a recent case involves cash kickbacks by an insider who was discharging patients. What providers fail to remember is that if there is an illegal kickback, that the entire claim is treated as a false claim even if it was performed and was medically necessary. 

On February 6, 2020, Jai Vijay of Sacramento, pleaded guilty to conspiring with the owners of home health care agencies and a hospice agency to pay and receive illegal kickbacks in exchange for Medicare beneficiary referrals.

According to court documents, Jai Vijay’s wife, Anita Vijay, worked as the social services director at a skilled nursing and assisted living facility in Sacramento. In her role, Anita Vijay assisted Medicare beneficiaries in selecting home health care and hospice agencies following their discharge from the facility. 

Anita Vijay used her position to steer Medicare beneficiaries to home health agencies in Folsom and El Dorado Hills and a hospice agency in Folsom. In exchange for the beneficiary referrals, the agencies’ owners paid Jai Vijay and Anita Vijay illegal cash kickbacks.

In his plea agreement, Jai Vijay admitted that the agencies’ owners paid him and his wife kickbacks in exchange for the referral of approximately 60 beneficiaries. Medicare paid the agencies approximately $400,000 for services they purportedly provided to the beneficiaries. Because the agencies obtained the beneficiary referrals by paying kickbacks, they should not have received any reimbursement from Medicare.

U.S. District Judge Troy Nunley is scheduled to sentence Jai Vijay on April 30. He faces a maximum statutory penalty of five years in prison and a fine of $250,000 or twice the gross loss or gain. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables.

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