Doctor Dubbed “King Of Nursing Homes” Downplayed Patient Harm From Illegal Kickback Scheme

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On August 8, 2016, federal prosecutors blasted Dr. Venkateswara Kuchipudi, a Chicago physician nicknamed the “King of Nursing Homes,” convicted of sending nursing home patients to a hospital he believed was subpar allegedly in exchange for free staff. According to prosecutors, the doctor attempted to “whitewash his actions” when asking for a lenient sentence and caused actual harm to patients to satisfy his “callous greed” (words prosecutors reportedly used).

Prosecutors argued that U.S. District Judge Matthew Canaille should give Dr. Venkateswara Kuchipudi a sentence that reflects how vulnerable his victims were and how much Dr. Kuchipudi profited from billing insurers for the work he didn’t pay his staff to do. In March 2016, Dr. Kuchipudi was convicted of a charge related to the illegal kickback scheme. Click here to read more.

The “King of Nursing Homes”

Dr. Kuchipudi earned the nickname “King of Nursing Homes,” from the hundreds of nursing home patients he treated and allegedly from accepting kickbacks for referring Medicare patients to Sacred Heart Hospital (in the Chicago area) in exchange for staff in 2016. The victims of Kuchipudi’s kickback scheme were “elderly and physically and/or mentally impaired nursing home-bound patients,” whose vulnerability gave Kuchipudi “nearly limitless discretion” over where they were treated, the government said in a sentencing memorandum. Dr. Kuchipudi allegedly chose a hospital he constantly criticized as “substandard” and that was located far from many of his patients, prosecutors said. Click here to read the sentencing memorandum in full.

Jeopardizing Quality of Care.

The government pointed out the victims at were brought to Sacred Heart Hospital on Dr. Kuchipudi’s orders, despite it not being the closest hospital, when they were suffering conditions that could have been life threatening, including heart attack, embolism and stroke. Other patients were forced to undergo unnecessary testing, stay at the hospital longer than necessary or, in one case, stay nine days to wait for surgery because the hospital lacked the proper equipment.

“Kuchipudi should never have sent an elderly patient with a broken hip to Sacred Heart if Sacred Heart did not have the equipment, such as a surgical table, already in place to provide necessary patient care,” the government said. “The table should wait for the patient. The patient should not have to wait nine days for the table.”

Additionally, Dr. Kuchipudi refused to work weekends or take calls at night, but wouldn’t let other doctors see his patients, so that he himself could bill for them, the memorandum states. Eventually Sacred Heart had to hire another doctor to take on Dr. Kuchipudi’s patients, for which he would then bill (according to prosecutors). This, by itself, would probably violate the Anti-Kickback Statute. According to prosecutors, when he was at the hospital, he would see his patients for 10 to 15 minutes total and make no notes, leaving the work to physician assistants and nurses.

He would often bill Medicare for the work done by these other physician assistants, nurses and the doctor the hospital hired for his patients, as if he did the work himself, the government stated.

In addition to having Sacred Heart pay for Dr. Kuchipudi’s staff, the physician received “well over $750,000” from insurers for their labor, the government said. As the kickback is more than $550,000, the offense level under the sentencing guidelines should increase, according to prosecutors.

Kuchipudi’s sentencing memorandum showed no signs of his acknowledging or feeling remorse for his crimes, the government said. Click here to read more.

To read a prior blog I wrote on illegal kickback schemes, click here.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Kass, Dani. “’King Of Nursing Homes’ Downplayed Patient Harm, Feds Say.” Law360. (August, 8, 2016). Web.

Eltagouri, Mawra. “Doctor known as ‘king of nursing homes’ convicted in kickback scheme.” The Chicago Tribune. (March 16, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: King of Nursing Homes, Medicare fraud scheme, Medicare audit, submitting false claims, Department of Justice (DOJ), health care fraud scheme, illegal kickback scheme, Medicare beneficiaries, services not rendered, unnecessary tests and procedures, improper billing, nursing home health facilities, health care kickbacks, Florida health care lawyer, The Health Law Firm
“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

OIG Alert Warns of Improper Conduct Involving Home Health Agencies and Physicians

michellebedoyaheadshotBy Michelle L. Bedoya, J.D. and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On June 22, 2016, the United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a fraud alert regarding improper arrangements and conduct involving home health agencies (HHAs) and physicians. The alert comes as a result of recent investigations and studies, where it has been found that home health fraud in Medicare continues to warrant scrutiny and attention from the OIG, its law enforcement partners, and the Centers for Medicare & Medicaid Services (CMS).

According to the alert, in the past year, home health agencies, individual physicians, and home-visiting physician companies have faced criminal conviction and civil settlements for defrauding Medicare because they have:

1) made or accepted payments for patient referrals;
2) falsely certified patients as homebound; or
3) billed for medically unnecessary services or for services that were
not rendered.

Payments in Return for Referrals of Beneficiaries.

Home health agencies were alleged to have violated the Federal anti-kickback statute (AKS) by directly or indirectly paying physicians in return for referrals of Medicare beneficiaries to home health agencies.

In turn, physicians were alleged to have violated the AKS because they directly or indirectly, either solicited or received payments from home health agencies in exchange for referring Medicare beneficiaries to those home health agencies.

These payments, between home health agencies and physicians, were sometimes disguised as compensation agreements for services provided. For example, a Medical Director agreement, which purportedly based compensation of a physician for services rendered as Medical Director of a home health agency, would act as a front of validity. According to the OIG, these agreements were actually mere guises for illegal payments for referrals of Medicare beneficiaries.

 

A Valid Compensation Agreement.

A valid compensation agreement for services, between home health agencies and physicians, must comprise of arrangements and payments that are commercially reasonable and at fair market value.

According to the OIG, payments that are made or received to induce referrals, raise the following concerns:

1) corruption of medical judgement;
2) patient steering;
3) overutilization;
4) unfair competition; and
5) increased costs to Federal health care programs.

Other Federal Law Violations.

According to the alert, the government also alleged that home health agencies, individual physicians, and home-visiting physician companies violated other federal laws such as the health care fraud statute and the statute that prohibits false statements relating to health care matters.

Conclusion.

Entities or individuals that are engaged in fraudulent activities involving federal health care programs, such as Medicare and Medicaid, are potentially subject to criminal, civil, and administrative sanctions.

Home health agencies and physicians should rely on experienced legal counsel for guidance in proper compensation agreements to ensure compliance with federal laws.

Comments?

What do you think of the OIG’s alert? Leave your comments below.

Contact an Experienced Health Care Attorney.

The attorneys of The Health Law Firm represent health care providers throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620.

Source:

“Alert: Improper Arrangements and Conduct Involving Home Health Agencies and Physicians.” U.S. Department of Health and Human Services: Office of Inspector General, 2016.

About the Authors: Michelle L. Bedoya, J.D., is an attorney with The Health Law Firm and a long-time consultant to home health agencies. George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Home health agency (HHA) lawyer, Florida health fraud defense attorney, health law defense lawyer, health professional attorney, nursing board defense attorney, home health agency defense lawyer, Medicare fraud defense attorney, Office of the Inspector General (OIG) investigation defense lawyer, OIG exclusion attorney, Medicaid fraud defense attorney, Medicare Fraud Strike Force attorney, home health agency (HHA) defense attorney, Zone Program Integrity Contractor (ZPIC) audit defense attorney lawyer, review of The Health Law Firm attorneys, The Health Law Firm, The Health Law Firm reviews, Nursing Service Organization (NSO) insurance defense attorney lawyer, Healthcare Providers Service Organization (HPSO) insurance defense attorney lawyer, Recovery Audit Contractor (RAC) audit defense attorney lawyer, Florida health attorney, Medicare fraud defense lawyer, Health care fraud statute, Medical Director agreements

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2016 The Health Law Firm. All rights reserved.

 

Colorado Judge Reduces Fraud Conspiracy Claims Against Aetna, UnitedHealthcare

5571 darken lighten center w skin softBy Carole C. Schriefer, R.N., J.D., The Health Law Firm
On July 14, 2016, a Colorado federal judge partly dismissed allegations against several surgical centers in claims filed by insurance companies Aetna and UnitedHealthcare. The judge disagreed that the two surgical centers committed fraud by waiving patient fees or violated antitrust laws by sending hefty bills to the insurers.

The dismissals applied to counterclaims filed by Aetna and UnitedHealthcare against four out-of-network surgical centers that are suing the insurers for allegedly blocking patient referrals. Although the centers accuse Aetna and UnitedHealthcare of anti-competitive efforts to destroy the centers’ business model, the insurers allege that the business model — which involves waiving patient fees and recruiting patients from in-network doctors — is itself illegal.

Click here to read more.

The Dismissed Allegations.

U.S. District Judge William J. Martinez, dismissed allegations of fraud and negligent misrepresentation against the two insurance centers. He did so after finding that the billing claims submitted to both Aetna and UnitedHealthcare disclosed “that the patient’s responsibility has been reduced to approximate in-network rates,” and that the insurers were therefore not deceived.

Additionally, the judge also dismissed counterclaims brought under state and federal antitrust laws. Those counterclaims were announced on an alleged price-fixing conspiracy among the insurance centers to bill insurers at 800 percent of Medicare reimbursement rates. Judge Martinez found that the two insurers had no obligation to pay the inflated rates and therefore were not harmed.

“To the extent [Aetna and UnitedHealthcare] paid a reimbursement that was artificially inflated by a price-fixing conspiracy, the injury was self-inflicted,” the judge wrote. “The court is unwilling to hold that paying an illegally inflated price constitutes antitrust injury when the paying party disregards its right to pay less or nothing at all.”

Counterclaims and Violations.

Judge Martinez also threw out several other counterclaims brought under other various theories and laws, including the Colorado Consumer Protection Act.

But he refused to dismiss counterclaims alleging tortious interference, unjust enrichment, civil conspiracy and violations of the Employee Retirement Income Security Act.

The judge said that the tortious interference counterclaim is potentially viable because both Aetna and UnitedHealthcare sufficiently alleged that inducing patients to “shirk their out-of-network cost-sharing” would violate Colorado’s abuse-of-health insurance statute.

To read Judge Martinez’s order in full, click here.

The case is Kissing Camels Surgery Center LLC et al. v. Centura Health Corp. et al.

Contact Health Law Attorneys Experienced With Healthcare Business Practices.

The Health Law Firm routinely represents physician groups and practices with issues involving establishing, licensing, selling, merging, and intergroup affiliation. If you are considering establishing an ACO or have been approached to become a participant in one, you can contact The Health Law Firm at (970) 416-7456 or (407) 331-6620 or (850) 439-1001 or you can visit our website at www.TheHealthLawFirm.com.

Source:

Overley, Jeff. “Aetna, Anthem, United Can’t Ax Referral-Blocking Claims.” Law360. (July 17, 2016). Web.

About the Author: Carole C. Schriefer is an attorney and registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.

KeyWords: Waiving patient fees, violating antitrust laws, healthcare fraud allegations, anti-competitive efforts, blocking patient referrals, legal representation for health care fraud allegations, Colorado Consumer and Protection Act, Colorado’s Abuse-of-health insurance statute, inflated Medicare reimbursement rates, Medicare fraud defense lawyer, health care fraud and abuse defense attorney, antitrust defense lawyer, legal counsel for antitrust allegations, Colorado health lawyer, The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.