Dr. Llewelyn Simon, an internal medicine physician from Monroe, recently agreed to pay the United States $640,000 to resolve allegations that he accepted payments for referrals of home health patients.
Acting U.S. Attorney Alexander Van Hook’s office announced the agreement on Tuesday.
Simon served as a medical director for the now defunct United Home Care home health agency and in that capacity, received monthly payments. The United States alleged that the medical director fees exceeded the fair market value of the services provided by Simon and that the excess fees were for referrals of patients, many of whom were Medicare beneficiaries.
“Improper financial relationships between health care providers can lead to overutilization and increase the cost of health care services paid for by the taxpayers,” said Van Hook. “We will continue to ensure that health care decisions are based on the needs of patients rather than the financial interests of providers.”
Congress passed the Anti-Kickback Statute to prevent financial incentives from improperly influencing medical decision-making which can lead to excessive and unnecessary services. Specifically, the Anti-Kickback Statute prohibits offering or paying anything of value to induce the referral of items or services covered by federal health care programs.
The investigation of this matter was conducted by the Department of Health and Human Service’s Office of Inspector General. Assistant United States Attorney Melissa Theriot handled the case. The resolution was the result of a coordinated effort between federal agencies and illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act.
Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).