PATIENT BROKERING
The Firm represents health care providers, sober home owners, individuals, and organizations under investigation or accused of patient brokering. The FBI, Florida Department of Health, Organized Crime Division, Department of Financial Services, and the Sober Home Task Force in Palm Beach County are responsible for conducting patient brokering investigations. Patient brokering, as amended, also is now a “predicate act” which may form the basis for racketeering prosecutions or lawsuits.
Patient brokering generally occurs when anything of value (commission, benefit, bonus, bribe, or rebate) is paid, solicited, or offered to induce the referral of patient to a particular health care provider or business. Patient brokering may also occur in the context of a “split-fee arrangement” where, for example, a health care provider refers a patient to a laboratory and the provider and laboratory split the reimbursement paid to the laboratory for services provided to that patient.
Importantly though, many compensation arrangements do not qualify as patient brokering as long as they satisfy an exception included in the statute or satisfy a safe harbor as provided in the federal Anti-Kickback statute. Some exceptions, include but are not limited to compensation arrangements in group practices, payments for professional consultation services, payments to insurance agents, payments to health insurers providing mental health or substance abuse services under health plan, payments to nurse registries. Subject to several important, additional criterion, payments to a health, mental health, or substance abuse information service or payments to provide health, mental health, or substance abuse goods or services under a health benefit plan when such payments are for goods or services under the plan may also satisfy an exception to the patient brokering statute.
The Firm is experienced in defending individuals accused of patient brokering. The Firm will formulate possible defenses, interview witnesses, and retain experts to rebut the Government’s findings.
Common schemes that the Government is investigating are as follows:
- Split fee arrangements between personal injury lawyers and medical providers for referring accident victims to a particular provider;
- Compensation provided to sober homes by laboratories and addiction treatment centers for referrals of patients also known as “body brokering.
- Compensation paid to patients to order a particular service, drug, or equipment.
- Recruitment and payments to patients at alcohol anonymous, narcotics anonymous, and other meetings to attend treatment.
- Free rent at sober homes or recovery residences to attend substance abuse treatment with a particular provider.
If you suspect that you are a target of a patient brokering investigation or have been contacted by the FBI, Florida Department of Health, Organized Crime Division of local law enforcement, the Department of Financial Services, the Sober Home Task Force in Palm Beach County, or a special investigative unit (SIU) of a health care plan, in connection with a patient brokering investigation, the Firm would be glad to schedule a consultation and may be reached at 305.714.9474.