Florida ALFs latest target of Medicaid fraud investigators

Assisted Living Facilities (ALFs), and the patient placement agencies with which they work, have become the latest target of Florida’s Medicaid Fraud Control Unit (MFCU) investigators.

Recently, these agencies have been conducting interviews with ALF owners, managers and marketing personnel at facilities where they suspect possible kickbacks in violations of the Florida Patient Brokering Statute and Florida Medicaid Provider Fraud Statute, Florida Statute 409.20(2)(a)(5), punishable by five years or more in prison.

It is a violation to:

Knowingly solicit, offer, pay, or receive any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind, in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made, in whole or in part, under the Medicaid program

These investigations may be born out of routine inspections conducted by Florida’s Agency for Healthcare Administration (AHCA).

ALFs are receiving criminal subpoenas from the MFCU requesting, among other things, that ALFs:

  • Provide copies of all contracts between the ALF and placement agencies
  • Provide the names and address of all placement agencies the ALF has used
  • Provide copies of all payment-related records pertaining to those placement agencies including invoices, check registers, bank statement and cancelled checks

Between January 2011 and August 2014, Florida’s Medicaid Fraud Control United has obtained more than $460 million in settlements and judgments, according to the agency’s own website.

Most of their investigations have centered on fraudulent billing schemes involving providers who bill for services never performed, kickbacks, overbilling for services provided, or billing for services that are medically unnecessary. ALF fraud is on MFCU’s radar.

It appears that investigators are now turning their attention to payment arrangements between ALFs and placement agencies and patient brokers. These are just the first subpoenas in a new effort by state prosecutors to root out ALF fraud.

Before making any admissions, providing statements or information requested by investigators or a subpoena it is imperative that ALF owners and operators contact an experienced attorney. Ignorance is not a defense. For the last 25 years, The Health Law Offices of Anthony C. Vitale has been representing providers who become the target of fraud and kickback investigations.

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The Health Law Offices of Anthony C. Vitale