Roseville Discharge Referral Kickbacks: Cash for the Patients on the List

In her guilty plea, a Roseville skilled nursing facility’s social-services director admitted receiving home health kickbacks for approximately 100 Medicare beneficiary referrals. The person helping patients choose an agency after discharge was taking money for sending them there. A nursing facility social worker who sees cash changing hands for home health referrals may recognize the arrangement. The director pleaded guilty on March 18, 2021.

What Is a Kickback Scheme?

Here, the alleged kickback scheme paid a facility employee after a home health agency accepted a patient she referred. The criminal charge filed against her alleged that the social-services director steered Medicare beneficiaries from the Roseville facility to two home health agencies, one in Folsom and the other in El Dorado Hills. It alleged that the arrangement ran from around January 2016 through around April 2019.

The charging document described a married couple who owned and controlled the agencies. The director sent one owner the names of beneficiaries she had referred. After an agency accepted a beneficiary, that owner paid the director cash or directed a family member to make the payment. The alleged exchange had a clear trigger: an accepted referral.

The government identified text messages sent around February 1 and March 13, 2019, each containing a list of beneficiaries referred to the Folsom agency. A list sent to the person paying for referrals can connect a facility’s discharge activity to an agency’s intake and a cash payment.

We see the breach of trust in that arrangement. Helping a patient select an agency was the director’s job. The alleged side payment turned that help into a sale. Patient choice, for cash.

The Medicare Money Went to the Agencies

The criminal charge tied approximately $735,000 in Medicare reimbursement to the director’s referrals within a network that received approximately $31 million for home health and hospice services. The agencies collected the reimbursement after buying access to the patients. That revenue explains why the owners were willing to pay someone who could steer a discharge their way.

The Justice Department’s account of the agency owner’s guilty plea named ANG Health Care Inc., Excel Home Healthcare Inc., and Excel Hospice Inc. as the businesses he and his wife owned and controlled. It described kickbacks to a hospital registered nurse, another facility’s social-services director and that employee’s spouse, as well as the Roseville director.

The owners were buying access to patients through people positioned to influence referrals. The Federal Bureau of Investigation and the Department of Health and Human Services’ Office of Inspector General investigated the owner’s case.

What Is Kickback in Healthcare?

In this case, the healthcare kickback was cash exchanged for directing a Medicare beneficiary to a home health agency. The criminal charge connected that payment to what Medicare later paid for the patient’s care.

The criminal charge described CMS Form 855A, the Medicare enrollment application whose signer promised compliance with the program’s payment requirements. It alleged that the agency owners had certified to Medicare that they would comply with its requirements, including not paying kickbacks for beneficiary referrals. It also stated that Medicare would not reimburse services whose underlying referral had been purchased with a kickback or bribe. The alleged contradiction sat inside the business: promise Medicare one thing, pay the referral source to do another.

The home health certification chain puts the discharge decision at the start of a longer path to payment. The agency’s patient assessment and the practitioner’s eligibility certification are separate steps. Here, the alleged purchase was access to the patient at discharge.

The charging document alleged that the agency owners and others then caused claims to be submitted for services to the referred beneficiaries. It described claims identifying the beneficiary, service, cost and date. Those details connect the patient on a referral list to the agency seeking payment.

What Evidence Is Needed to Prove Fraud?

In the Roseville criminal charge, the evidence connected the discharge decision, the accepted referral, the cash and the Medicare claim. The charging document identifies the director’s selection role, beneficiary lists, the payment after acceptance and the agencies’ resulting claims.

A facility social-services worker may know who selected the agency and how the referral list was prepared. An intake employee may know when the agency accepted the patient and who supplied the name. Someone handling payments may know why cash was released or who instructed a family member to deliver it. A biller may see the beneficiary and services on the claim. These are different views of the same transaction.

We connect those views to understand who controlled the referrals and why the money changed hands. The text messages in this case matter because they identify patients within the alleged arrangement. The account becomes much more useful when the person who knows the list can explain what sending it meant inside the business.

What Evidence Is Needed to Report Fraud?

Your firsthand knowledge of the referral arrangement is the starting point for a conversation with us. We work with you to connect what you saw to the people making the decisions and the records that show the payment. You may know the discharge side, the agency side or the cash arrangement. Our work is to understand how that knowledge fits the whole case.

What Are Some Examples of Home Health Care Fraud?

Paid discharge referrals are one example of home health care fraud. Payments for access to patients also appear in patient recruiter arrangements, while other cases show payments to the practitioner whose signature allows care to proceed.

The Justice Department’s trial account involving Delta Home Health Care described an agency owner paying a hospital discharge nurse. That case places the referral decision in a hospital, while the Roseville director worked at a skilled nursing facility. The institution changes. The employee’s ability to direct patients remains valuable to the agency paying for access.

In a separate criminal-case opinion involving Grand Home Health Care, the court described payments to a physician of $400 for new-admission forms and $300 for recertifications. The patients needed home health care and chose their agencies independently from brochures. The physician was paid for the signatures that allowed the agency to proceed.

In Roseville, the alleged purchase was the director’s steering of patients. In the Grand case, it was the physician’s certification and recertification. The person controlling the next decision could be paid at a different point in the patient’s path.

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. If you know how an agency paid for referrals and billed Medicare for the resulting care, our whistleblower experts can assess that civil case with you.

You Know Why That Agency Got the Patient

If you saw referral lists turn into cash payments, tell our whistleblower experts how the discharge arrangement worked. We build the case around your knowledge of the facility and agency, bring in home health fraud whistleblower lawyers who understand paid referrals, and stay beside you through the process to build your strongest home health whistleblower case.