Florida Health Care Clinic "Consultant" and Biller Pleads Guilty in Marketing Partial Hospitalization Program And Directing Payments to Patient Brokers in Exchange for Patient Referrals

In the past, aggressive health care entities would seek to avoid the limits of federal and state anti-kickback statutes and federal STARK laws by creating consulting, marketing and outreach agreements that appeared on their face to be compliant. 

Federal investigations are filing health care fraud cases based on the marketing arrangements that when reviewed reveal payments for the referral of patients with essentially no other "marketing" or services performed. 

When the marketing entities are investigated, they tend to show cashed checks, payments to others for referral of patients, and other evidence of payments for patients. Legal marketing payments are not supposed to include payments for the referral of patients.

A recent case shows that the government is being aggressive on illegal marketing arrangements.  Nery Cowan, a former Miami health care clinic consultant and Medicare biller, pleaded guilty on January 14, 2016 in connection with her marketing role for a defunct Miami-area health care provider. She pleaded guilty before U.S. District Judge Beth Bloom of the Southern District of Florida to one count of conspiracy to commit money laundering. Ms. Cowan will be sentenced by Judge Bloom on March 25, 2016.  

According to the factual basis, Ms. Cowan served as a consultant and Medicare biller for Greater Miami Behavioral Healthcare Center Inc. (Greater Miami), a partial hospitalization program (PHP) that purported to provide intensive treatment for severe mental illness. According to court documents, from 2006 through 2014, Greater Miami billed Medicare approximately $63 million for purported mental health services.

Ms. Cowan was involved in directing the payment of kickbacks to patient brokers and others in exchange for Medicare beneficiary referrals. Ms. Cowan admitted that she received a percentage of the Medicare reimbursement from Greater Miami’s PHP as compensation. This means that getting the percentage as a biller could be problematic when there is illegal referral fees being paid.

Ms. Cowan admitted that she, along with co-defendants Dean Butler and Irina Mora, took great lengths to conceal kickback payments to shell companies owned by “patient brokers” who, on behalf of Greater Miami, solicited Medicare beneficiaries from assisted living facilities, halfway houses and drug courts located throughout the Southern District of Florida.  

Ms. Cowan admitted that she, Butler and Mora disguised these monthly kickbacks as “outreach” or “marketing” payments through HNB-Stell Care Inc., a sham staffing company. On Nov. 30, 2015, Judge Bloom sentenced Mr. Butler to 16 years in prison and Ms. Mora to nine years in prison following their guilty pleas.

Posted by Tracy Green, Esq.