Healthquest Florida: The Referral Case Brought by a Former Marketer

In the Healthquest Florida settlement, Healthquest, Inc. and its owners agreed to pay $1.5 million to resolve allegations that the company used marketer kickbacks to induce Medicare home health referrals. A former marketer for the company brought the whistleblower case. The person who challenged the payments came from inside the referral business itself.

The U.S. Attorney’s Office for the Southern District of Florida announced the settlement on July 16, 2018. Healthquest operated in Palm Beach Gardens, Florida.

What the Healthquest Florida Settlement Covered

The government alleged that Healthquest paid kickbacks to its marketers from December 2013 through May 2017 to induce them to refer patients for home health services. The alleged exchange was money for patient referrals. That puts the arrangement between the agency and the marketer at the center of the case: what the agency was paying for, and why the marketer sent patients there.

Home health agencies receive patients through hospital discharge planning and community practices. A hospital discharge planner evaluates the patient’s needs, available services and access with the patient and caregivers. The hospital discharge rules preserve patient choice and require disclosure of a hospital’s financial interest in a referred agency. That is what buying referrals distorts: the choice of an agency should follow the patient’s needs, while a kickback rewards the person steering the business.

The U.S. Attorney’s Office and the Department of Health and Human Services Office of Inspector General coordinated the resolution. The settlement resolved allegations that the agency paid marketers to refer Medicare patients.

The Former Marketer and the Government’s Case

A former Healthquest marketer filed the qui tam case under the False Claims Act. The government joined her case and took primary responsibility for pursuing it.

The U.S. Attorney’s Office also announced that the whistleblower would receive a share of the recovery. Her role matters to another marketer reading this: knowledge of the payment arrangement can be central to a home health whistleblower case. You may understand what management expected in return for the money even when someone else handled the clinical records or billing. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

Independent Review of the Referral Arrangements

The Healthquest resolution included a five-year Integrity Agreement with the HHS Office of Inspector General. It required an Arrangements Review that included both a systems review and a transaction review, conducted by an Independent Review Organization. For a contracting or compliance employee, the distinction is recognizable: how a relationship is set up and how money moves under it.

The Florida and New York Health Quest Cases

Healthquest, Inc. in Palm Beach Gardens is separate from Health Quest Systems in New York. The New York settlement was a larger, combined resolution of more than $14.7 million covering home health claims with inadequate face-to-face documentation, inflated office-visit billing and physician compensation tied to referrals. The Florida case concerns alleged payments to marketers.

What Is Kickback in Healthcare?

A kickback in healthcare buys referrals or other business paid for by a government health program. In the Healthquest case, the government alleged that payments induced marketers to send patients to the agency for home health services.

The Anti-Kickback Statute connects claims resulting from prohibited referral payments to the False Claims Act. That is why the purpose of a marketer payment can matter to a Medicare claim submitted later. The allegation reaches back to how the agency obtained the patient.

In announcing Healthquest’s settlement, the U.S. Attorney described the broader harm from kickbacks: higher health care costs and services driven by profit rather than patients’ interests, including unnecessary home health care. We see the absurdity: money meant to care for patients becomes a reason to buy access to them.

The home health certification chain continues after the referral. Eligibility, the clinical assessment, the plan of care and the visits each need their own support.

The referral, the clinical records and the claim can sit with different people. Someone who sees the money paid to a marketer may hold a different part of the story from the person who sees the resulting Medicare claim.

Other Florida Referral Cases Show the Payment Behind the Job Title

Other Florida home health cases show how a marketing job or a clinical title can carry an alleged referral payment. In the A Plus Home Health Care case, the government alleged that the agency employed physicians’ spouses in nominal marketing jobs requiring little or no real work. The alleged referral expectations and compensation induced the physicians to send Medicare patients to the agency.

A marketing salary for little or no marketing. The alleged value to the agency was the physician’s referrals. The whistleblower in that case was a former director of development, another insider from the part of a home health business responsible for growth.

In the Recovery Home Care case, the government alleged that excessive compensation for physician medical-director or chart-review work induced home health referrals. There, the alleged payment sat inside a clinical working relationship.

These cases give the insider a useful comparison: the job description, the work performed and the referrals expected in return. Each arrangement puts the same practical question in a different place: what was the agency buying with that money?

The Payment, the Referral and the Medicare Claim

For a marketer-payment case, we connect what the agency paid, what it expected in return and the patients and claims that followed. An intake employee may know where a referral came from. A marketer may know the expectations attached to compensation. A billing employee may see the claim and the payment record.

The payment record shows what Medicare actually paid for the care. Connecting that payment to the referral arrangement is how we bring the marketer’s knowledge to bear on the government’s bill.

You Know What the Referral Was Worth

If you worked in marketing, intake or billing and know how an agency paid for referrals, talk with our whistleblower experts about the arrangement you saw. We build the case with you, bring in home health fraud whistleblower lawyers who understand referral-payment arrangements, and stay beside you as the case develops.