A Sarasota, Florida home health care agency, Doctor’s Choice Home Care, Inc., has agreed to pay $5.8 million to resolve whistleblower claims that they violated the False Claims Act (FCA). The whistleblowers, all former employees of Doctor’s Choice, claim that the company’s former owners, Timothy Beach and Stuart Christensen, violated the FCA’s Anti-Kickback Statute by creating illegal financial relationships with physicians. According to a November 20 press release from the U.S. Department of Justice (DOJ), Doctor’s Choice disguised an illegal kickback scheme as “medical director agreements” and paid doctors for referring patients to the home health care agency. Kickbacks are illegal because they jeopardize the physicians’ ability to make the best decisions for their patients without being influenced by outside financial incentives. The complaint alleges that many of these kickbacks were paid through the doctor’s spouses, who were also employees of the company.
The DOJ alleges that Doctor’s Choice artificially increased the number of services they provided during visits to meet the minimum number of services required to prevent Medicare from decreasing their reimbursement. Without adding these extra and unnecessary services, the DOJ says that the Low Utilization Payment Adjustment would have kicked in and cut down on Doctor’s Choice’s bottom line. If a home visit consists of fewer than 5 skilled service visits over the course of a treatment, Medicare will pay the home care company at a lower rate. To resolve this specific claim, Doctor’s Choice will pay $675,000.
Two whistleblower lawsuits were filed against Doctor’s Choice: the first by a single individual, Corina Herbold, and the second by three other former employees, Marina Eschoyez-Quiroga, Sara Billings, and Misty Sykes. Both lawsuits were filed under the qui tam provisions of the False Claims Act, which allow whistleblowers to file lawsuits on behalf of the government. Whistleblowers can receive rewards based on the total amount of money recovered by the government for fraud that they reported. Under the False Claims Act, whistleblowers can receive between 10 and 30% of the total settlement. Eschoyez-Quiroga, Billings, and Sykes will all share a $145,000 reward. The reward for Herbold’s lawsuit has not yet been determined.