California Skilled Nursing Facilities, Owner and Management Company Agree to $45.6 Million Consent Judgement to Settle Allegations of Kickbacks to Referring Physicians
Two South Florida medical doctors and their wives have agreed to settle allegations that they violated the False Claims Act when their wives accepted sham marketer salaries in exchange for their husbands’ referrals to a home health care company called A Plus Home Health Care Inc., the Justice Department announced today. Under the settlements, Dr. Alan and Lynn Buhler will pay to the United States $1.047 million and Dr. Craig and Cynthia Prokos will pay $90,000. Dr. Buhler practices in Plantation, Florida, and Dr. Prokos practices in Jupiter, Florida.
“Kickbacks can corrupt the judgment of physicians and cause them to make decisions for their own financial benefit rather than for the benefit of their patients,” said Acting Assistant Attorney General Joyce R. Branda of the Justice Department’s Civil Division. “We will not tolerate these conflicts of interest where Medicare patients and dollars are concerned.”
“The settlement announced today is another example of the Justice Department’s unrelenting efforts to hold accountable those who engage in kickback schemes,” said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida. “Health care providers should generate business by offering their patients superior care. Financial relationships that put profits over patients undermine the quality and care given to patients and ultimately, the integrity of our public health care program upon which millions of Americans depend.”
The United States alleged that, beginning in 2006, A Plus and its owner, Tracy Nemerofsky, engaged in a scheme to increase Medicare referrals in the heavily saturated home health care market in South Florida. Specifically, the United States alleged that A Plus paid spouses of referring physicians for sham marketing positions in order to induce patient referrals. Among the spouses allegedly paid by A Plus as part of this scheme were Lynn Buhler and Cynthia Prokos. The United States alleged that the spouses were required to perform few, if any, of the job duties they were allegedly hired for and instead, the spouses’ salaries were intended as an inducement for the husband physicians to refer their Medicare patients to A Plus. The United States also alleged that Alan Buhler received medical director payments as part of A Plus’s scheme to obtain his referrals and he attempted to hide those payments from the United States.
The United States previously settled with A Plus, Tracy Nemerofsky and five other couples that allegedly accepted payments from A Plus.
The settlements announced today resolve allegations that were brought by William Guthrie, a former director of development at A Plus, under the qui tam or whistleblower provisions of the False Claims Act, which permit private parties to sue on behalf of the United States for the submission of false claims and to receive a share of any recovery. On Jan. 6, Judge William P. Dimitrouleas dismissed Mr. Guthrie’s suit without prejudice to the United States’ right to proceed. The lawsuit was captioned U.S. ex rel. Guthrie v. A Plus Home Health Care, Inc., 12 CV 60629 (S.D. Fla.).
“Being a physician in the Medicare program is a privilege, not a right,” said Special Agent in Charge Derrick L. Jackson of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “Physicians who engage in such in-your-face kickback schemes to refer Medicare patients to certain home health companies in exchange for money will be held accountable for their behavior. Our agency will continue to crack down on kickbacks, which undermine impartial medical judgment, corrode the public’s trust in the health care system and waste scarce Medicare funding.”
These settlements illustrate the government’s emphasis on combating health care fraud and mark another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $23.7 billion through False Claims Act cases, with more than $15.2 billion of that amount recovered in cases involving fraud against federal health care programs.
The investigation of this matter reflects a coordinated effort among the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Southern District of Florida, HHS-OIG and the FBI.
The claims resolved by the settlements are allegations only and there has been no determination of liability.