What does your office do to recruit new patients?  Newsletters, Advertising, etc?  Some healthcare providers hire “patient recruiters” to pick up patients and transport them to their practice.  BEWARE:  This can amount to fraud.

In Brooklyn NY, a patient recruiter plead guilty to $13 million dollars in healthcare fraud scheme involving Cropsey Medical Center.

“…Working through an ambulette company in Brooklyn, [the defendant] recruited patients to attend Cropsey Medical.  An ambulette is a vehicle that is licensed by New York State’s Medicaid program to transport beneficiaries to and from medical facilities when such transportation is medically necessary.  From 2009 to 2012, [the defendant] paid employees of Cropsey Medical a per beneficiary cash kickback so that Cropsey Medical would accept [the defendant’s] beneficiaries as patients and so that [his] ambulette company could bill Medicaid for the transportation of beneficiaries to and from Cropsey Medical.  Once [the defendant’s] beneficiaries were transported to Cropsey Medical, they were paid cash kickbacks to induce them to continue to attend the clinic and to receive medically unnecessary physical therapy, diagnostic testing and other services.  Such purported medical services were then billed by Cropsey Medical to Medicare and Medicaid.

According to court documents, from approximately November 2009 to October 2012, Cropsey Medical submitted more than $13 million in claims to Medicare and Medicaid, seeking reimbursement for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy and diagnostic tests.”

Department of Justice, September 6, 2013

How can you avoid being accused of fraud?  First, it is clear that patient’s cannot be paid to come to your office.  Whether it’s cash or a coupon for free services, this will be viewed as a kickback to the patients for using your healthcare services.  Likewise, you can not pay referring physicians or give them gifts for the referrals.  Giving away hockey tickets to your best referring doctors can get you into trouble.  These activities are easy to detect and the feds will accuse you of fraud.

Secondly, the issue of transportation for patients should be carefully reviewed.  Many offices currently provide free transportation for patients as it is difficult for elderly, sick patients to get to their doctor’s office.   This can be seen as a kickback for patients to use your healthcare services.

This is especially true if the majority of your patients have Medicare and Medicaid.  As ObamaCare expands the Medicaid population, offices need to be especially careful not to provide a free service that could be seen as a  “kickback.”  To provide transportation, your office needs to carefully review how to provide transportation that is legal.

Share Your Ideas here  and tell us how your office recruits patients without violating the kickback rules.  We’d love to hear from you.

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