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TX nurse accused of health care fraud, faces 5 years jail time

Officials with the Eastern District of Texas charged a local nurse of violating the federal Anti-Kickback Statute (AKS). According to the allegations, the registered nurse owned a health care services company that provided home health services to patients. The prosecution stated the nurse ran afoul of the law when she made payments to community liaisons to encourage Medicare beneficiaries to use her services.

Fair business agreement or illegal practice?

What could seem like a fair business model can actually be a violation of federal law, as was the case in this situation. The prosecution was able to gather evidence to support the claim the agreement was a violation. This included information the agreement led to financial gain in return for community liaisons encouraging patients to use a specific health care provider.

The government states this plan resulted in over $225,000 in fraudulent claims to Medicare for payment for home health services.

How can health care professionals make sure their business deals are in line with the law?

Health care professionals can mitigate the risk of a legal challenge or federal investigation by having legal counsel review a business plan before moving forward. In arrangements like the one in the case above, it is wise to seek legal counsel. This is true for nurses and other health care professionals who are looking at an initial plan similar to the one outlined in the case above, facing an investigation or fighting similar allegations of wrongdoing. An attorney experienced in health care claims that involve nurses can help to better ensure your interests are protected.

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