A Plus Home Health: Physician Spouses on the Marketing Payroll

In the A Plus Home Health kickback settlement, A Plus Home Health Care Inc. and its owners agreed to pay $1.65 million to resolve allegations that sham marketing jobs bought physicians’ Medicare referrals. The spouse received the salary. The physician was allegedly expected to supply the patients. For someone inside marketing, payroll or intake, the revealing detail was what allegedly happened when the referrals fell short: the spouse lost the job.

A Plus was a home health care company in Fort Lauderdale, Florida. The U.S. Attorney’s Office for the Southern District of Florida announced the agency and owners’ settlement on September 17, 2014. A former director of development at the company brought the whistleblower case, and the government joined it.

Home Health Physician Spouse Fake Marketing Job Allegations

The alleged fake marketing jobs paid physicians’ spouses while requiring few, if any, actual duties. In its account of the government’s complaint, the Justice Department said A Plus began the alleged scheme in 2006 to increase Medicare referrals in South Florida’s heavily saturated home health market.

The complaint alleged that the agency hired at least seven physicians’ spouses and one physician’s boyfriend for marketing positions. Their salaries allegedly served as both an inducement and a reward for the physicians to send Medicare patients to A Plus. The government’s account said an owner allegedly fired at least two spouses when their husbands failed to refer a certain number of patients.

We see an extraordinary definition of marketing performance here: the alleged employee could have almost no duties, while the employee’s husband had a referral target. A job title on one side of the household, a patient quota on the other.

The Referral Starts a Longer Medicare Payment Trail

For a case about purchased referrals, we connect the spouse’s payroll entry to the physician’s patient stream and the agency’s Medicare claims. The home health certification chain, OASIS assessments and visit records let us follow those patients from referral through care and billing. The comparison puts the salary beside the Medicare business it allegedly bought.

That is why the development office, payroll department and clinical team can each see something different. The employee who knows the hiring arrangement may understand the promised referrals. An intake employee may recognize the patients arriving from that physician. A biller may know which admissions became paid claims. We work with the insider to bring those views together.

The Owner’s Salary and the Referral Business

The government’s complaint also connected the alleged scheme to money inside A Plus. According to the Justice Department’s account, an owner received a $685,000 salary in 2010, when the agency’s business increased through Medicare referrals generated by the alleged sham marketing arrangement.

One owner’s salary for a single year was a sizable share of the agency and owners’ eventual settlement. We want to know who benefited when those referral numbers rose, and who decided how to keep them rising.

Separate Settlements for the Agency and Physician Couples

The A Plus matter reached the agency, its owners and people alleged to have accepted its payments through separate settlements. By the time the agency and owners resolved their part, the government had already settled with five couples that allegedly accepted payments from A Plus.

The Justice Department then announced separate settlements with two more physician couples on February 23, 2015. A physician practicing in Plantation, Florida, and his wife agreed to pay $1.047 million. A physician practicing in Jupiter, Florida, and his wife agreed to pay $90,000. The government alleged that both wives held sham marketing positions with few, if any, duties, and that their salaries were intended to induce their husbands to refer Medicare patients to A Plus.

Medical-Director Payments to the Plantation Physician

The government also alleged that the Plantation physician received medical-director payments as part of A Plus’s effort to obtain his referrals and attempted to hide those payments from the United States. That allegation added a payment directly to the physician alongside the salary paid to his wife.

The distinction matters to an insider who knows the payment records. A marketing salary and a medical-director fee appear under different descriptions, but the government alleged that both served the same referral objective.

What Is a Kickback Scheme?

A healthcare kickback scheme buys referrals or business through payments or other benefits. In the A Plus allegations, the salary went to a physician’s spouse while the physician supplied the Medicare referrals. The alleged exchange ran through an employment relationship rather than a payment labeled as a referral fee.

The Anti-Kickback Statute addresses deliberately buying referrals for care paid for by federal health programs, whether through cash or other benefits. The same attention to what compensation buys runs through sham marketing arrangements with patient recruiters. A Plus adds a particular route: the referring physician’s household received the alleged benefit.

Compensation through a spouse also appeared in the government’s settled allegations against Medical Services of America and Traditional Home Care. There, the government alleged that bonuses paid to a physician’s spouse depended on the physician’s referrals. Those allegations concerned Stark, the physician self-referral law, which also covers financial relationships involving a physician’s immediate family. The shared business question is concrete: which referrals determined the employee’s compensation?

We see the problem for patients and honest agencies: when a household’s paycheck depends on referrals, the paying agency has bought a reason to be chosen. The A Plus allegations put that incentive inside the physician’s household.

What Evidence Is Needed to Prove Fraud?

For a case about nominal jobs and physician referrals, the evidence connects the promised work, the work actually performed, the compensation and the Medicare business it was intended to generate. We examine those connections with the person who knows how the arrangement operated.

A job description can explain what a marketer was supposed to do. The employee’s actual work and management’s expectations can explain whether that description matched the arrangement. A decision to end the job when a spouse’s referrals fell short, as the government alleged here, can make the payment’s purpose much clearer than the title on a payroll report.

The A Plus whistleblower’s development role is especially relevant to that comparison. This case began with someone inside the function responsible for growing the business.

If you recognize the arrangement from your own work, your understanding of what management expected may be the part the finished paperwork leaves out. Our whistleblower experts work with you on that account and its connection to the claims.

How Much Does Medicare Fraud Whistleblower Pay?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. In a referral-payment case, our work starts with what you know about the arrangement, who controlled it and the Medicare business it generated. In the spouse-bonus case discussed above, the settlement agreement set the whistleblower’s share at 18 percent of any payment received by the United States.

You Know What Kept the Job on the Payroll

If a spouse’s marketing job depended on a physician’s Medicare referrals, speak to one of our Whistleblower Experts about how the referrals were paid for. We build the case with your knowledge of the business and bring in home health fraud whistleblower lawyers who understand physician compensation and Medicare claims. You have our expertise and partnership from the first conversation through the pursuit of a recovery.