Sept. 18: Week That Was in Healthcare Fraud and Malpractice

Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.

FL. hospital to pay $69.5M for false claims allegations

The North Breward Hospital District has settled to pay $69.5 million for false claims allegations, according to the Department of Justice. The hospital district had allegedly violated the False Claims Act and the Stark Statute by providing above market value compensation in exchange for physician referrals. The Stark Statute states that hospitals may not maintain financial relationships with physicians in exchange for hospital referrals.

Attorneys on the case laud the department’s efforts in addressing these inappropriate relationships, not only because these relationships are unethical but because they can potentially affect patient care and the price of healthcare.

“The Department of Justice has long-standing concerns about improper financial relationships between health care providers and their referral sources, because those relationships can alter a physician’s judgement about the patient’s true health care needs and drive up health care costs for everybody,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.

This was a whistleblower case under the qui tam provision of the False Claims Act which states that a private citizen may report a suit to the federal government in exchange for a portion of the monetary recovery. The whistleblower in this case, Michael Reilly, MD, brought the case to the government and received $12,045,655.55 in return.

Mother and daughter sentenced for healthcare fraud

Connie and Stephanie Robbins, both of Virginia, were sentenced in a United States District Court on Monday, September 14, on one count of conspiracy to commit healthcare fraud. Additionally, the two will have to pay Virginia Medicaid $137,106 in restitution.

The pair reportedly ran Robbins CD Services, a company which provides oversight for a Consumer Directed Service Facilitator (CDSF). CDSFs provide at-home care nurses to Medicaid patients in an effort to keep them out of a nursing home. These services are paid for by Virginia Medicaid.

Both Connie and Stephanie Robbins were the only two employees of Robbins CD, with Connie working as a registered nurse and Stephanie working as the office manager. Connie reportedly created false paperwork reporting in-person visits with patients which never occurred, and Stephanie knowingly processed and submitted this information to Virginia Medicaid. According to the Department of Justice, approximately 35 percent of the claims made by Robbins CD never occurred.

Both women pled guilty to the charges of conspiracy to commit healthcare fraud. Connie was sentenced to one year and one day in prison, while Stephanie was sentenced to two years of probation, 200 hours of community service, and three months of home confinement.