McAllen, Texas – The creators of an Edinburg hospice and affiliated home health agency have reimbursed over 1.8 million U.S. dollars to settle claims they submitted submissions to the Medicare program that originated from illicit referrals, reported Ryan K. Patrick, United States Attorney.
Sedat Necipoglu, from McAllen, age 48, and Onder Ari, from Edinburg, age 49, founded Verge Home Care LLC and Allstate Hospice LLC. Sedat Necipoglu, Onder Ari, Home Care LLC, and Allstate Hospice LLC have currently reimbursed 1,847,279.36 U.S. dollars following an inquiry into fraudulent reimbursement to doctors for referrals.
The investigation started in 2016 and discovered that Sedat Necipoglu and Onder Ari provided compensation to doctors who were liable for a substantial majority of their patient referrals. Precisely, they offered doctors with monthly reimbursements according to medical directorship deals with Verge Home Care LLC and Allstate Hospice LLC. Those reimbursements exceeded the fair market value for the services the doctors actually offered.
Sedat Necipoglu and Onder Ari further traded interests in Allstate Hospice LLC to five different doctors which eventually obtained them significant quarterly dividends. They further offered doctors other benefits and gifts, like travel and tickets to sporting events.
The Stark Law, which is also referred to as the Physician Self‑Referral Law, bars specified entities from charging the Medicare program for specific services referred by doctors with whom the entity has a financial affiliation unless that relationship meets one of the law’s regulatory or statutory exceptions. The Anti‑Kickback Act prohibits giving or reimbursing kickbacks to persuade the referral of services or items that Medicaid, Medicare, and other taxpayer-funded programs cover. Both the Anti-Kickback Act and the Stark Law are designed to ensure the patient’s best interests and that inappropriate financial incentive do not undermine medical decision-making.
Federal Bureau of Investigation – San Antonio Division Special Agent in Charge Christopher Combs stated that the Federal Bureau of Investigation is persistently committed, together with its law enforcement partners, to taking measures to eradicate inappropriate relationships and kickbacks that can undermine the integrity of doctor decision-making and inflate health care costs. Special Agent in Charge Christopher Combs further stated that together with criminal prosecution, the Federal Bureau of Investigation would further seek administrative and civil remedies with the USAO (United States Attorney’s Office) and their law enforcement partner investigative agencies, to deter, prevent, and recover government losses caused by fraud, abuse and waste.
The Health and Human Services Department – Office of Inspector General Special Agent in Charge Miranda Bennett stated that reimbursing doctors to refer patients to one healthcare provider over another unbearably undermines patient choice. Special Agent in Charge Miranda Bennett further assured that they would persistently continue to collaborate with their law enforcement partners to inquire improper reimbursements to doctors to safeguard patients and the integrity of the health care programs from corrupt acts.
The HHS (United States Department of Health and Human Services) – Office of the Inspector General (OIG) and the Federal Bureau of Investigation carried out the investigation together with the USAO (United States Attorney’s Office). The United States Assistant Attorney Brad Gray carried out the prosecution of the case.
The claims settled by this resolution are just allegations, and there has been no determination of responsibility.
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