Jackson & Coker: Staffing Fees Tied to Approved Orders

In the Jackson & Coker settlement, the staffing company and a physician formerly of Richland, Washington, agreed to pay $700,000 to resolve allegations of telemedicine kickbacks involving medically unnecessary durable medical equipment and diagnostic laboratory testing. The company’s contract charged for approved orders. The physician signed nearly all the orders he reviewed, yet never spoke with the beneficiaries whose treatment the paperwork purported to describe.

The U.S. Attorney’s Office for the Eastern District of Washington announced the settlement on March 15, 2024. In the settlement agreement, Jackson & Coker and the physician admitted the facts about what each of them did and knew. Those facts put the staffing business inside the Medicare order chain, even though Jackson & Coker did not submit the Medicare bills.

How Jackson & Coker Entered the Medicare Order Chain

Jackson & Coker LocumTenens sources physicians and other medical professionals for clients. Its role here was to place a physician with Nationwide Health Advocates for contracted telemedicine work. The physician worked through that arrangement from April through September 2021.

Nationwide used telemarketing companies to contact Medicare beneficiaries about equipment or laboratory testing at no cost to them. The telemarketers collected personal information and used it to generate physician orders and supporting documentation. The paperwork made it appear that a physician was treating a specific medical problem and ordering equipment or testing as part of that treatment.

Nationwide sent the prepared orders and supporting material electronically to the physician, who electronically signed them. Suppliers and laboratories then billed Medicare on the resulting orders. Nationwide paid Jackson & Coker, and Jackson & Coker paid the physician.

That sequence matters to someone inside a healthcare staffing company. The client brought the beneficiary information and prepared order. The staffing company brought the physician. The physician supplied the approval that let the order move toward a Medicare claim. The clinical decision sat inside a commercial arrangement already organized around producing orders.

The Health and Human Services Office of Inspector General described this industry pattern in its July 2022 telemedicine fraud alert: companies recruit patients and practitioners, supply information for review, pay for reviews or signatures, and transfer the resulting orders to downstream buyers. The order itself can be what the business sells. An encounter bill is only one place to look for the money.

The Staffing Fee Depended on Approved Orders

The approved order payment in the Jackson & Coker settlement was a fee to the staffing company. The agreement describes a $45 daily administrative fee charged to Nationwide and a $35 fee for an approved order.

The staffing company’s order fee depended on approval, and nearly every review ended in approval. For an insider who knows the invoicing system, the contract puts a price on the physician’s decision.

The agreement also describes customer payment problems. We would examine the terms alongside the invoices, payments and approval records to see how the arrangement actually operated.

The fee schedule tells an insider what the staffing company charged. The signed order tells a supplier or laboratory what the physician supposedly decided about a patient. Comparing those documents brings the transaction into focus: what the client bought, what the physician did, and what the signature represented.

The Orders Represented Care That Did Not Happen

The physician neither treated nor spoke with the beneficiaries for whom he placed Nationwide orders. The supporting documents nevertheless represented a treating relationship.

The Justice Department’s account of Medicare coverage explains why that representation mattered. The equipment or genetic test had to be ordered by a physician treating the beneficiary for a specific medical problem and used in the course of that treatment.

A telemarketer had spoken with the beneficiary. The signing physician had not. Medicare picked up the bill for orders that represented care those beneficiaries never received.

In the separate case involving MySpecialistMD, the physician admitted approving genetic tests for beneficiaries she was not treating.

What the Jackson & Coker Settlement Covers

The settlement amount was a joint obligation of the staffing company and the physician. The agreement describes more than $750,000 in Medicare payments on the physician’s orders. Medicare paid out more on those orders than the two of them agreed to pay back.

Nationwide’s former owner and president also admitted his part in the scheme. According to the Justice Department’s announcement, he agreed in September 2023 to plead guilty to health care fraud conspiracy charges in Massachusetts. In his criminal plea agreement, he admitted that he and Nationwide participated in fraudulently billing Medicare for false equipment and laboratory-testing orders issued by physicians who were not treating the beneficiaries.

Client Vetting Was Part of the Staffing Company’s Role

The settlement announcement connects staffing companies’ responsibilities to vetting contract physician opportunities for possible fraud. Jackson & Coker received credit for cooperating with investigators and improving its compliance efforts and controls for telemedicine placements.

That puts client selection and the proposed work at the center of the staffing story. The physicians were independent contractors. Jackson & Coker’s alleged involvement concerned procuring the orders that produced claims, even though the company did not bill Medicare itself.

The Inspector General’s alert identifies features a staffing or compliance employee may recognize: recruitment around free products, inadequate patient contact or information, compensation tied to order volume, and no expected or practicable follow-up. Those are concrete questions about the assignment a company offers a clinician. Who supplies the patients? What information reaches the doctor? What earns the fee? What happens after approval?

In a separate RediDoc physician settlement, the government’s account described a physician who reviewed recorded telemarketing calls and prefilled prescriptions, expressed doubts about the work’s legitimacy in writing, and continued signing orders. That parallel adds the internal warning to the payment and order records. A concern raised inside the business can show what someone understood while the work continued.

The Records That Show What an Approved Order Really Bought

The useful evidence connects the staffing agreement to the approved order and the Medicare claim that followed. An invoice shows what triggered a charge. An approval record shows the decision that triggered it. The original beneficiary information, actual encounter record and signed order show whether the medical account matches what happened.

For a staffing employee, the contract and payment records may be the strongest part of that chain. A physician may know what information appeared in the review queue and whether patient contact was possible. A supplier or laboratory employee may know which signed documents supported the claim. We bring those perspectives together around the same orders.

A 2024 Rutgers University Law Review article, Plausible Cause: Connecting the FCA and AKS in the Context of Health Care Fraud, asks how a kickback is tied to the bills it produces. It points to the Inspector General’s telemedicine alert as a way to spot arrangements built to produce those bills.

For this case, that gives the fee schedule a practical use beyond showing what each participant charged. We connect the approval that earned the staffing fee to the order that supported a supplier’s or laboratory’s bill. Internal warnings and changes to the review process can help explain what people knew about that connection.

You Know What Triggered the Fee

If you saw a staffing contract reward approved orders while patient care existed only on the forms, talk with our whistleblower experts about the arrangement. We build the case with you around the payments, the signatures and what the people running the operation knew, and bring in telehealth fraud whistleblower lawyers who understand staffing and Medicare billing. From the first conversation through the case, we are your partners in holding the people behind those orders accountable. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.