Most referrals to specialists or facilities happen for good reasons. But sadly, some healthcare providers send patients to specific clinics or people in exchange for kickbacks.
These illegal payments harm patients and waste taxpayer money. When healthcare decisions focus on profits instead of patient needs, everyone loses—except the fraudsters.
Below are four signs to help you spot kickback schemes in healthcare services.
Strange patient referral patterns
Notice when doctors consistently send patients to the same facilities without good medical reasons. For example, a doctor might refer all patients to a lab across town when better options exist nearby. Some providers might order tests you don’t need just to send business to their friends.
Questionable financial decisions
Healthcare providers often try to disguise illegal kickbacks as normal business deals. Watch for red flags like:
- Doctors paying unusually high rent for office space
- Medical experts getting paid way above regular rates for advice
- Speakers receiving large payments for simple presentations
- Joint venture arrangements with uneven profit-sharing
These arrangements often mask illegal payments for sending patients to specific providers.
Suspicious marketing deals
Some providers use fake marketing agreements to hide kickbacks. Look for marketing staff who receive bonuses based on referral numbers or providers who offer free services in exchange for referrals. If the marketing costs seem disproportionate to the actual services provided, you may want to ask questions.
Paperwork problems
Pay attention to missing or altered documentation about referral relationships. You might notice providers who pressure staff to delete or modify records about financial arrangements if you do. Look for inconsistencies between what providers tell Medicare or Medicaid and what their own papers show.
Protecting patients and taxpayers
If something seems wrong, start keeping detailed notes about what you see—but don’t take any documents home. More importantly, avoid telling coworkers or posting about it online. Instead, seek advice from a legal professional.
A qui tam whistleblower attorney can help evaluate your observations and evidence. They can guide you through proper reporting channels while protecting your rights and job.
