A recent article in a home health care industry publication lays out a compelling argument against a bounty system that punishes individuals and companies that have done nothing wrong. Their "crimes" are often little more than bookkeeping errors, insufficient documentation or simply being in the wrong place at the wrong time and getting pulled into one of many investigations launched in pursuit of big paydays from whistleblower lawsuits.
Even when there's no finding of wrongdoing, government investigators will issue threats of prosecution that can bring companies to the negotiating table eager to settle and make it all go away.
Sometimes settling is simply cheaper than letting a health care fraud investigation go on for weeks and months, eating up company time and resources while dragging its reputation down to depths from which it might never recover. Another threat investigator will deploy, knowing the long-term financial repercussions for many in the home health care industry: excluding a company from future Medicare or Medicaid participation.
There are already nearly 70,000 providers excluded from participating in the federal programs and a major source of revenue for suppliers, doctors, pharmacists, nurses, salespeople, etc.
One example of ways in which suppliers can come under investigators' microscopes is when they pay percentage commissions to contractor salespersons. What's the risk? "The government believes such payments can induce referrals." Like magic, you or your firm could be discussing the ramifications of your "participation" in an illegal kickback scheme.
If you or your health care company is under investigation, don't hope and trust that it will all work out. Instead, speak to an Austin law firm experienced in representing clients facing inquiries into potential fraud, Anti-Kickback Statute violations and related matters.