A home health care business with an office in Orange Park will reimburse more than $5.1 million to the government.
Doctor’s Choice Home Care Inc. and its former executives, Timothy Beach and Stuart Christensen, agree to pay $5.15 million to resolve allegations that the agency provided improper financial inducements to referring physicians through fraudulent agreements with medical directors and bonuses to physicians’ spouses who were Doctor’s Choice employees, according to a Nov. 24 news release from the U.S. Attorney for the Middle District of Florida.
The claims resolved by the settlement are allegations and there has been no determination of liability, the release states.
Doctor’s Choice will pay $3,856,000 to settle the allegations and Beach and Christensen each will pay $647,000.
In addition, Doctor’s Choice will pay $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 unnecessary services.
Doctor’s Choice is based in Sarasota with branches throughout the state. Beach and Christensen founded Doctor’s Choice and formerly served as its top executives.
The 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.
The Anti-Kickback Statute prohibits the offering or payment of remuneration to induce or reward referrals for services paid for by federal health care 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.
The agreement also resolves allegations that Doctor’s Choice provided unnecessary services to Medicare patients to increase the number of skilled service visits provided during a home health episode to avoid the Low Utilization Payment Adjustment which otherwise would have decreased Doctor’s Choice Medicare reimbursement.
The allegations resolved in the 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.
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) 447-8477.