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Kickback & Stark Violations

The care a patient receives should be based on what is reasonable and necessary for the treatment of that patient...

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Illegal Referrals of Medicare Patients Lead to Criminal Convictions

Last Thursday, the Department of Justice issued press releases in two cases involving illegal referrals of Medicare patients. In each case, the defendant was convicted of receiving kickbacks from home health care agencies in exchange for referring Medicare beneficiaries.

Kentucky Man Sentenced to 60 Months in Prison

Last summer, Dominic Trumbo was found guilty after a four-day jury trial in the Eastern District of Michigan. Trumbo was convicted of conspiring to pay and receive health care kickbacks and three counts of solicitating or receiving kickbacks in connection with a federal health care program. Last week, he was sentenced to five years in prison and ordered to pay over $1 million in restitution and forfeit $203,000.

The evidence at trial showed that Trumbo was responsible for recruiting over 4,000 Medicare beneficiaries for home health agencies across the country. Employees of his company, Trumbo Consulting Agency, “cold called” Medicare beneficiaries and induced them to sign up for home health care services. Trumbo then sold information about those beneficiaries to home health agencies. In addition, Trumbo and his co-conspirators created sham contracts and fake invoices to conceal their illegal kickback scheme.

California Man Pleads Guilty to Kickback Scheme

In the other case, Jai Vijay pleaded guilty to conspiring with the owners of home health care agencies and a hospice agency to pay and receive kickbacks in exchange for Medicare beneficiary referrals. Vijay admitted in his plea agreement that he and his wife, Anita, had received kickbacks for referring approximately 60 beneficiaries.

Anita Vijay worked as social services director at a skilled nursing and assisted living facility in Sacramento. In that role, she assisted patients in selecting home health care and hospice agencies when they were to be discharged. Co-conspirators paid Vijay and his wife cash in exchange for Anita steering Medicare beneficiaries to their agencies.

Vijay is scheduled to be sentenced on April 30, 2020. He faces a maximum sentence of five years in prison and a fine of at least $250,000.

Illegal Referrals Violate the False Claims Act

Accepting payments in exchange for medical referrals is a classic violation of the Anti-Kickback Statute. The AKS prohibits medical providers from offering, soliciting, paying, or receiving anything of value in exchange for referrals of patients whose treatment will be paid for by a federal health care program. The AKS is a criminal provision. In addition, any claims that are tainted by kickbacks are false or fraudulent under the False Claims Act.

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