Lindsey, a medical provider, makes monetary payments to existing patients and other providers for referring new patients. What is this scheme called?

• A. Beneficiary fraud
• B. Deductible forfeiture
• C. Fictitious services
• D. Kickback

Answer: (D)

The main idea here is illegal compensation to influence referrals. In healthcare, paying someone to steer patients to a particular provider or facility is called a kickback. This scheme matches that term because the provider is giving money to existing patients and other providers specifically to obtain new patient referrals, creating a financial incentive to refer. Such payments are governed by anti-kickback laws in the United States, which prohibit knowingly offering or receiving remuneration to induce referrals for items or services reimbursed by federal health programs, with serious penalties for violations. The other terms describe different fraud scenarios that don’t involve paying for referrals: beneficiary fraud involves manipulating benefits for personal gain, deductible forfeiture concerns failing to cover a deductible, and fictitious services involve billing for services never performed. Kickbacks directly target referrals and are the classic example of this improper scheme.