If what the government alleged were true, it would be an emergency physician’s dream job: billing for services without ever treating or even speaking with the patient.
What could go wrong?
Jackson & Coker LocumTenens, LLC (“Jackson Coker”) is a large healthcare staffing company. Between April and September 2021, Jackson Coker placed Edward William Salko, D.O. (“Salko”), an emergency medicine physician by training, to provide contracted telemedicine services for a company known as Nationwide Health Advocates (“Nationwide”), owed by David Santana (“Santana”).
According to Santana’s guilty plea in a related criminal prosecution, he, through Nationwide and another entity, entered into arrangements with telemarketing companies to develop leads by targeting Medicare beneficiaries. The telemarketers then paid Nationwide on a per-order basis to generate orders for DME and genetic lab tests for those beneficiaries.
To arrange for the orders to be signed, Santana and Nationwide worked with medical staffing companies to find doctors and nurses who were willing to review and sign prepopulated orders, typically without any contact with the beneficiaries. The records falsely portrayed the medical providers as having performed a legitimate examination of the beneficiary. The signed orders were then sent to the telemarketing companies which sold the orders to DME suppliers and laboratories to be used to submit claims to Medicare for DME and genetic testing that were medically unnecessary, based on false documentation, and tainted by kickbacks.
Which takes us to the allegations against Salko and Jackson Coker.
The government alleged that Jackson Coker placed Salko as one of the physicians to whom Nationwide sent physician orders and supporting documentation and that Salko electronically signed the orders, despite the fact that he was not treating, and never spoke with, any of the beneficiaries for whom he placed the orders. The orders were then billed to Medicare, with Nationwide paying Jackson Coker, and Jackson Coker paying Salko on a per order basis. Specifically, Jackson Coker charged Nationwide a daily $45 administrative service fee plus $35 for each order reviewed and approved by Salko, and Jackson Coker paid Salko $15 for each order reviewed and approved by him.
On March 15, 2024, the U.S. Attorney for the Eastern District of Washington announced that Salko and Jackson Coker agreed to pay $700,000 to resolve the kickback/no medical necessity scheme allegations against them.
Note that those allegations were civil, not criminal, in nature, and that although Salko and Jackson Coker admitted underlying facts, the settlement was made without them admitting any liability.
Some Takeaways For You
- Kickback deals almost always come with discernable red flags. Be on the lookout for them, even if your participation begins by way of an introduction from an otherwise reliable source. Being asked to sign prepopulated physician orders for patients you’ve never treated, spoken with, or seen, and then being paid on a per-order basis, count as burning-hot-as-a-dwarf-star red flags.
- Just because your introduction to the “arrangement” comes via a well-known or even trusted source doesn’t obviate your own responsibility to vet the situation.
- With physician shortages in many specialties opening up lucrative opportunities for locums work, temporary staffing is undergoing a boom. The twist is that sometimes it can be a bust. Be a locums if you wish, just don’t do something loco.
