(STL.News) Doctor’s Choice Home Care, Inc. and its former owners, Timothy Beach and Stuart Christensen, have agreed to pay $5.15 million to resolve allegations that the home health agency provided improper financial inducements to referring physicians through sham medical director agreements and bonuses to physicians’ spouses who were Doctor’s Choice employees, the Department of Justice announced today.
Timothy Beach and Stuart Christensen founded Doctor’s Choice and formerly served as its top executives. Doctor’s Choice is a home health agency based in Sarasota, Florida, with branches throughout the state.
Doctor’s Choice will pay $3,856,000 to settle these allegations and Beach and Christensen will each pay $647,000. Doctor’s Choice will pay an additional $675,000 to resolve separate allegations that employees pressured clinical personnel to increase the number of home visits for Medicare patients to avoid the Medicare Low Utilization Payment Adjustment that would have decreased the reimbursement Doctor’s Choice received from Medicare in the absence of these unnecessary services.
“The Department of Justice will continue to hold companies and individuals accountable for the payment of illegal remuneration in any form,” said Acting Assistant Attorney General Jeffrey Bossert Clark of the Department of Justice’s Civil Division. “Improper inducements have no place in our federal healthcare system, which relies on healthcare providers making decisions based on the healthcare needs of their patients and rather than their personal financial interests.”
“Operating an illegal referral scheme and providing medically unnecessary services places patients at risk and jeopardizes millions of taxpayer dollars,” said Special Agent in Charge of the FBI Tampa Division Michael McPherson. “This settlement highlights the FBI’s commitment to protect the integrity of the federally funded healthcare system.”
The Anti-Kickback Statute prohibits the offering or payment of remuneration to induce or reward referrals for services paid for by federal healthcare programs. The Stark Law forbids certain medical providers, including home health agencies, from submitting claims to Medicare for services provided to patients who were referred by a physician with whom the provider has a prohibited financial relationship, unless that relationship falls within an applicable exception.
This settlement resolves allegations that Doctor’s Choice, Beach, and Christensen violated the Anti-Kickback Statute and the Stark Law by entering into sham medical director agreements with physicians as a means of providing remuneration for referrals, and also violated the Stark Law by providing bonuses to employees based on referrals to Doctor’s Choice by the employees’ physician spouses. In addition, the agreement resolves allegations that Doctor’s Choice provided unnecessary services to Medicare patients in order to increase the number of skilled services provided during a home health visit to avoid the Low Utilization Payment Adjustment which otherwise would have decreased Doctor’s Choice Medicare reimbursement. This adjustment is triggered when a home health patient has a treatment episode consisting of less than five skilled service visits and results in the provider receiving a standardized per visit payment rather than the higher payment for a full home health episode.
The allegations resolved in this settlement were originally brought in two lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act; one case was filed by Corina Herbold and the second case was filed by Sara Billings, Misty Sykes, and Marina Eschoyez-Quiroga, all of whom are former employees of Doctor’s Choice. The Act permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery. Billings, Sykes, and Eschoyez-Quiroga will jointly receive a share of approximately $145,000 arising from the government’s recovery for the Low Utilization Payment Adjustment allegations. Herbold’s share has not yet been determined.
The government’s intervention in these matters illustrates its emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).
The settlement was the result of a coordinated effort by the Civil Division of the Department of Justice, the U.S. Attorney’s Office for the Middle District of Florida, the Office of Inspector General of the Department of Health and Human Services, and the FBI.
The cases are captioned United States ex rel. Herbold v. Doctor’s Choice Home Care Inc., et al., No. 8:15- cv-01044 (M.D. Fla.) and United States ex rel. Billings, Sykes, and Eschoyez-Quiroga v. Doctor’s Choice Home Care Inc., No. 8:16-cv-3112 (M.D. Fla.).
The claims resolved by the settlement are allegations only; there has been no determination of liability.