Free Transportation to Behavioral Treatment: What the Free Ride Buys

Behavioral health transportation kickbacks turn a ride into a payment for treatment referrals or attendance. A facility offers the trip, the patient arrives, and the treatment generates insurance claims. For someone in admissions, transportation or billing, the revealing details are who chose the destination, who absorbed the travel cost, or what the patient had to keep doing to receive the benefit. The transportation arrangements alleged at Turning Point and Oglethorpe put those decisions at the center of the case.

Turning Point’s Flat Fee for a Plane, Bus or Van

Turning Point Care Center allegedly subsidized patients’ travel to bring them into treatment. The facility, part of Universal Health Services in Moultrie, Georgia, agreed to a $5 million transportation settlement announced in July 2020. The government alleged that free or discounted transportation induced Medicare and Medicaid beneficiaries to enter detoxification, rehabilitation or intensive outpatient treatment.

The whistleblower’s complaint described a transportation price that stayed the same even when the means of travel changed:

The complaint puts the facility’s transportation spending inside the referral story: what did the business expect in return for subsidizing the trip?

The same complaint alleged that Turning Point financed patient housing through a cash-paid bookkeeper and separate accounting records. Patients allegedly remained in intensive outpatient treatment longer than necessary to keep their subsidized housing, while the facility continued billing Medicare. Travel brought the patient in. Housing allegedly supplied a reason to stay enrolled. Taxpayers were billed for care the complaint said was unnecessary.

The transportation expense, the housing arrangement and the treatment claim describe different parts of the same patient’s relationship with the facility. Someone who sees the subsidy may know something the person submitting the claim does not.

Free Long-Distance Rides and Psychiatric Hospital Kickbacks

Free long-distance rides figured in psychiatric hospital kickback allegations against Oglethorpe and its Ohio facilities. In a March 2021 settlement, Oglethorpe and its Ohio facilities agreed to pay $10.25 million. The government alleged that free long-distance transportation induced Medicare beneficiaries to use treatment services. It also alleged unnecessary psychiatric admissions at Cambridge Behavioral Hospital and Ridgeview Behavioral Hospital.

A former client advocate brought the whistleblower case.

A separate Oglethorpe whistleblower complaint alleged that marketers were paid according to the value and volume of Medicare and Medicaid patients they brought into inpatient treatment. It also alleged that marketers at The Willough at Naples promised horseback riding and spa services that the facility did not have. The promised destination was part of the sales pitch.

For an insider, the referral communications explain why a particular facility was selected. The clinical and billing records explain what happened after arrival. We examine those together, including who offered the travel benefit and how the arrangement depended on the patient entering or remaining in treatment.

Who Pays for the Ride and Who Controls the Referral?

The treatment operator, marketer, housing business and billing organization can each control a different part of a patient’s arrival. The payment trail has to follow those roles through to the claim.

A treatment operator’s corporate filing described a centralized admissions center handling benefits verification, insurer communications, screening, precertification, facility selection and logistics. That operating model shows how much happens before a clinician sees the patient. It also identifies where an insider may see the decision about coverage beside the decision about destination.

The ride’s funding, the patient’s eligibility for the billed treatment and the organization’s authority to submit that claim each belong in the examination. We connect the actual payment terms to what the healthcare business represented it had delivered.

Is This Patient Brokering?

Patient brokering involves paying for patients or referrals. We assess the benefit, its recipient and the conditions attached to it with you, including whether a ride depended on choosing a particular treatment provider.

A patient broker paid a percentage of insurance reimbursement has a direct interest in the treatment bill. In its account of an Orange County broker’s guilty plea, the Justice Department described referrals exchanged for shares of private-insurance proceeds. The money followed the patient into treatment and then back to the broker.

A rehab marketing fixed-fee contract can conceal compensation paid per patient. In its account of the criminal trial that convicted the operator of Healing Path Detox and Get Real Recovery, the Justice Department described marketing arrangements labeled as fixed fees while actual compensation depended on insurance reimbursement and billable days. An addiction center’s insurance value and days billed determined the referral payment behind the contract’s label.

A paid recruiter disguised as a case manager can leave a similar trail. In its account of the Reflections Treatment Center operator’s guilty plea, the Justice Department described kickbacks disguised as case-management and consulting fees. For someone who sees transportation invoices beside marketing payments, the useful question is what each payment actually purchased.

When Housing and Other Benefits Buy Attendance

When sober home rent depends on attending one treatment center, the housing payment can reveal the same condition as the ride. Bournewood admitted paying sober homes only while patients enrolled in and attended its partial hospitalization program. Recovery housing payments stopped when partial hospitalization attendance stopped, regardless of continuing housing need. The payment followed attendance.

Payments to the housing operator can also buy referrals. In its account of the criminal trial that convicted Spectrum Care’s owners, the Justice Department described payments to group-home operators and recruiters for patients in a Medicare scheme. Patients who did not qualify for partial hospitalization spent time watching movies, coloring or playing games. Payments from Spectrum Care’s owners to group-home operators for patient referrals can be connected to the clinic’s Medicare claims.

Gift cards for Medicaid counseling attendance raise the same question about what the benefit purchases. In its account of the Aptihealth civil settlement, the Justice Department described allegations of gift cards rewarding attendance and Medicare and Medicaid claims for services that were not provided. The comparison with transportation is the condition attached to the benefit and the care behind the claim.

What Evidence Is Needed to Prove Fraud?

Useful evidence connects the travel benefit and referral terms to the patient’s attendance, actual treatment, payer and paid claim. We work through that connection with the insider who knows how the arrangement operated.

Transportation invoices and patient charges can show who absorbed the cost. Referral communications can explain who selected the destination and what was promised. Attendance records, treatment notes and claims can show whether the service represented to the payer matches what happened. The accounting records can connect the subsidy to the business receiving the treatment revenue.

Transportation Authorization and Treatment on the Same Date

Medicaid can also pay transportation providers for the ride itself. A September 2022 HHS Inspector General audit of New York City transportation payments shows why the transportation manager’s file and the treatment provider’s file belong together. The audit covered nonemergency medical transportation during 2018 and 2019. It reviewed records from the contractor managing the program, medical providers and transportation providers.

The audit estimated at least $84,329,893 in improperly claimed federal Medicaid reimbursement for transportation payments that did not meet federal and state requirements. It recommended that New York refund that money.

The Inspector General recommended controls connecting the authorization and practitioner’s order to the ride, documenting driver and vehicle qualifications, confirming that the beneficiary received a Medicaid-covered service on the transportation date, and matching the billed service to the service authorized and provided.

What Evidence Is Needed to Report Fraud?

Your knowledge of the arrangement gives us a starting point: the travel promise, the payment condition, the destination and the claims it generated. Our health care fraud whistleblower experts assess those facts with you and pursue the connection to the government’s payments. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

When You Know Who Paid for the Ride

If you work in admissions, transportation, marketing or billing and know how travel benefits were tied to treatment revenue, speak to one of our whistleblower experts about who paid for the ride. We build your strongest behavioral health whistleblower case around the connection between the ride, the referral and the claim, and bring in behavioral health fraud whistleblower lawyers who understand patient-inducement cases. We stay beside you from that first account of how the business worked through the pursuit of your case.