What is patient brokering and why is it illegal?

On Behalf of | Jan 19, 2021 | Medicare and Medicaid Fraud

Patients who do not have professional relationships with physicians may look for referrals. While there is usually nothing wrong with referring a patient to another health care professional, accepting a fee for doing so may violate Florida law.

In Florida, patient brokering is a type of health care fraud. Usually, patient brokering happens when someone refers patients to a health care provider or facility in exchange for a benefit, bribe, bonus, rebate or kickback. Fee-splitting arrangements may also violate Florida law.

What motivates physicians to broker patients?

Individuals in Florida may have private insurance or public coverage, such as Medicaid or Medicare. These insurance programs may pay a considerable amount for health care services. Consequently, physicians or others may have a financial incentive to refer patients who can pay for costly medical procedures.

What are the penalties for patient brokering?

In Florida, prosecutors may charge patient brokering as either a first-, second- or third-degree felony, depending on the nature of the conduct and the number of brokered patients. Regardless, a conviction for patient brokering may include a fine of between $50,000 and $500,000 and a possible prison sentence.

What are some defenses to criminal charges?

Like with any other criminal offense, prosecutors much prove each element of patient brokering beyond a reasonable doubt. Still, there are many exceptions to Florida’s patient brokering law that may help a person avoid a criminal conviction. For example, it may be permissible to split fees for referrals within the same practice group.

Ultimately, though, whether a defendant may take advantage of a legal exception probably requires an in-depth analysis of the facts and circumstances of both the referral and the payment.


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