Jackson & Coker LocumTenens: The Staffing Payments Behind Prewritten Orders

In the Jackson & Coker DME settlement, the health care staffing company and a physician agreed to pay $700,000 jointly over allegations of a Medicare kickback scheme involving medically unnecessary durable medical equipment and diagnostic laboratory testing. The government alleged that the doctor received payment for each order he reviewed, although he never spoke with the beneficiaries. A staffing employee may recognize the arrangement through the placement and payments, before ever seeing a Medicare claim.

The Justice Department announced the resolution on March 15, 2024. Jackson & Coker LocumTenens sourced physicians and other medical professionals for clients. According to the government, its client in this arrangement was Nationwide Health Advocates, which used telemarketing companies to reach Medicare beneficiaries. The physician, formerly of Richland, Washington, provided contracted telemedicine services through the staffing firm.

How the Staffing Payment Chain Worked

The government alleged that Nationwide paid Jackson & Coker, and Jackson & Coker paid the physician. The document chain began with a telemarketing call and ended with orders billed to Medicare.

According to the government’s account, telemarketers working for Nationwide contacted beneficiaries about equipment or laboratory testing at no cost to them. They collected personal information and used it to prepare a physician order and supporting documentation. Those documents made it appear that the physician was treating a specific medical problem and ordering the equipment or test as part of that treatment.

The government alleged that Nationwide sent the prepared order and supporting material electronically to the physician. He signed electronically, and the orders were then billed to Medicare.

That sequence matters because different businesses handled different parts of it. In the durable medical equipment trade, attracting a customer, obtaining beneficiary information, supplying a clinician, producing an order and fulfilling it can involve separate contracting parties. The supplier receives the order and bills for the equipment. The staffing company sees the placement and compensation arrangement that put the clinician into the process.

The HHS Office of Inspector General’s July 2022 telemedicine alert describes arrangements involving call centers, staffing companies, practitioners, marketers and brokers. The person arranging the doctor’s work may know how that work was sold to the doctor, even when the eventual supplier sits elsewhere in the chain.

A Prescriber Paid Per DME Order Through a Staffing Company

A prescriber paid per durable medical equipment order through a staffing company was central to this case: Jackson & Coker paid the physician for each order reviewed, and he approved nearly all of them, according to the government. The arrangement ran from April through September 2021.

According to the government, the physician reviewed orders others had prepared for people he neither treated nor spoke with. Medicare was billed, the government alleged, for equipment and testing backed by a treatment relationship that existed only on paper.

The settlement announcement explains why that difference mattered to Medicare payment. For the equipment and genetic testing at issue, coverage required an order from a physician treating the beneficiary for a specific medical problem, with the item or test used in that treatment. The alleged paperwork supplied the appearance of precisely that relationship.

For a clinician who recognizes this kind of review queue, who prepared the medical account is as important as who signed it.

What the Staffing Records Could Show

Staffing records can connect the client’s request, the clinician’s assigned work and the payment for completing it. A medical chart may describe a treatment decision. A placement agreement may explain what the doctor was actually retained to do.

In this case, the government’s account connects a telemedicine assignment with electronically supplied orders and payment per review. Client instructions, placement communications and payment records may explain that relationship from inside the business.

The industry has several names for the paid task. HHS-OIG describes compensation presented as payment for a review, audit, consultation or assessment of medical charts. It also describes companies selling the resulting order or prescription to others. That makes the work assignment commercially important: the clinician’s completed review can produce something another business buys.

We work with staffing insiders to connect what they saw in the assignment and payment process to the medical representations and resulting claims. Someone who handled the placement may understand a client’s expectations. Someone who handled compensation may understand what counted as completed work. Those perspectives can explain the business arrangement behind an order that looks clinical on its face.

What Are Some Red Flags for Medicare Fraud?

Payments tied to order volume, too little patient information to assess medical need and medical histories that appear to be templates are among the features HHS-OIG describes in suspect telemedicine arrangements. These are concrete features a staffing employee or reviewing clinician may encounter in the work itself.

What the Settlement Says About Jackson & Coker

Jackson & Coker settled alongside the physician, and the government also credited the company with full cooperation and changes to its controls. The Justice Department said the company took significant remedial action to improve legal and compliance efforts and internal controls for placing providers with telemedicine clients.

That response concerned the same part of the business that put the physician into the arrangement: vetting the client’s opportunity and placing a provider.

Nationwide’s operator made a separate admission in the criminal case. As the Justice Department’s announcement recounts, in his plea agreement the former owner and president admitted his and Nationwide’s participation in fraudulently billing Medicare for false equipment and laboratory orders issued by physicians who were not treating the beneficiaries.

When the Signed Order Is What Gets Sold

In the AZ Diabetic Supply case, the government alleged that the supplier bought completed prescriptions from LPI.

A Whistleblower Case About Staffing Payments

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

For an insider who recognizes the arrangement described here, the starting point is the work: what the client requested, what the physician received, what the review accomplished and how payment followed it. Our whistleblower experts assess that account with you and build the case around the connection between the commercial arrangement and the claims charged to Medicare.

You Know What the Review Was Paid to Do

If you handled telemedicine placements, review assignments or the payments behind them, speak to one of our whistleblower experts about how those reviews were paid. We work beside you to develop the case and bring in healthcare fraud whistleblower lawyers who understand paid orders and Medicare billing. Your knowledge of the staffing business stays central as we build your strongest whistleblower case together.