Medicare Fraud – Kickbacks – sufficiency of the evidence

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U.S. Court of Appeals For the Seventh Circuit

Criminal

Medicare Fraud – Kickbacks – sufficiency of the evidence

The certification and recertification, via Form 485, of patients for treatment constitutes a “referral” under the Anti-Kickback Statute.

“[I]t is irrelevant that Patel’s patients received treatment from Grand before he signed their Form 485s. Even though care had begun, Grand could not have charged Medicare for that care prior to receiving a signed Form. The referral process, as far as Medicare is concerned, continues until the Form is signed. Patel could have withheld his signature in an attempt to extort larger payments from Grand. In fact, it seems that Patel once threatened to do just that when Encinares lacked the money to pay him. If Patel had decided not to sign the forms, Grand could not have billed Medicare. In other words, the prospect of a kickback gave Patel an increased incentive to charge Medicare for these services—exactly the type of incentive that Congress sought to eliminate by passing the Anti-Kickback Statute.”

Affirmed.

14-2607 U.S. v. Patel

Appeal from the United States District Court for the Northern District of Illinois, Dow, J., Flaum, J.

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