Pitfalls of Financial Kickbacks in the Senior Health Care Sector

One of the main pitfalls associated with financial kickbacks in exchange for senior referrals or placement is that the entire senior health care sector suffers. The senior being placed suffers, the reputation of the greater senior referral industry suffers, the family of said senior suffers, and most importantly, the credibility of certain senior living establishments suffer. 

Case Managers or discharge planners who contravene the federal anti-kickback law could see themselves facing legal action that may lead to jail time, as well as other consequences. The anti-kickback law prevents anyone from offering or giving anything to generate senior referrals. This law benefits our seniors and their families. 

Recently, owners of a home health agency and hospice pled guilty to fraud by paying kickbacks to numerous individuals for patient referrals. According to court documents, this included one count of conspiracy to commit health care fraud and another to receive healthcare kickbacks. The guilty parties had a registered nurse and two directors.

Of the $31 million paid to providers, The Medicare Program paid over $2 million for services provided to patients who were referred for kickbacks. As referrals were gained by paying kickbacks, the providers should have received no payment from the Medicare program for services rendered to the patients. By law, discharge planners/case managers cannot accept the following from providers who want referrals:

• Cash
• Any cash equivalent such as gift cards/gift certificates
• Cashless items of a high value
• Free discharge services that case managers/discharge planners and social workers are obligated to provide

Social Workers and discharge planners provide an essential service that is appreciated and highly valued by many patients and their families. But, unfortunately, the confidence and trust placed in them are ruined by healthcare providers who make referrals based on financial payment or kickbacks.

The office Inspector General of the US Department may hold anyone in management, including CEOs, responsible for kickbacks whether or not they knew or should have known. It is imperative for those in charge to monitor and stay vigilant of any activities that may lead them to believe that case managers/discharge planners are receiving kickbacks. Procedures should be put in place about anything received from providers, or better yet, a policy that disallows all gifts. 

It is thus crucial that adult children and their families ask the right questions and ensure that problems are addressed before placing their seniors in any community. The right senior living community should suit your senior’s individual needs and provide you and your family with total peace of mind. Kickbacks should have no part in this, and health workers who participate will face the full might of the law. 

This underlines the importance of using case managers, or placement agents who are vetted, fully insured, and credible. At Options for Senior Living, we take pride in the fact that all our placement experts are part of the NPRA, as well as PASRS.

©2021 Elizabeth E. Hogue, Esq. All rights reserved.