Last month, a Joint Stipulation of Dismissal was filed on behalf of a home health service provider and its affiliated entities settling a qui tam action for violations of the Federal False Claims Act ( “FCA”). The defendants submitted claims and were paid at least $1M for home health services that were not covered by the Medicare program, and that they failed to refund overpayments received from Medicare for these claims. The U.S. Attorney’s Office for the Northern District of Georgia announced that the defendants agreed to pay $4.2 million dollars[1] to resolve the allegations in the Complaint without any admission of liability.
Home health services providers furnish care to homebound beneficiaries who suffer from acute illnesses and injuries. Tto prevent fraud and abuse, and as a condition of payment under the Medicare program, practitioners must certify to the patient’s eligibility for the home health benefit and, to the extent that there is a need for continuous home health care services after the initial 60-day episode, recertification is required every 60 days.[2]
As described in the Complaint, from January 1, 2011 to June 30, 2012, the defendant, a for profit corporation operating 16 home health agency locations, violated the FCA by knowingly submitting claims that were either undocumented or uncertified, and failing to refund payments for these claims. Further, the relator, a former employee and office administrator, alleged that defendant retaliated against her after she submitted a complaint regarding defendant’s conduct. Shortly after her complaint, the relator received written discipline for alleged poor performance, and that discipline led to her termination. Notably, the defendant did not discipline or terminate other office administrators for comparable performance. The relator will receive over $700,000.00 from the settlement.
This case highlights the potentially devastating consequences for home health providers that disregard their compliance obligations under federally funded programs. As warned by U.S. Attorney Kurt R. Erskine in connection with this case, “The Medicare and Medicaid programs depend on providers to submit only those claims that are eligible for reimbursement and to promptly notify the programs if they receive payments to which they are not entitled.”
Home health providers that submit false claims and/or do not promptly refund overpayments potentially face serious civil and criminal consequences. For example, on November 30, 2021, the Department of Justice announced that an Illinois woman had been sentenced to 56 months in prison and ordered to pay $6.3 million[3] in restitution in connection with conspiracy to commit health care and wire fraud for claims billed to Medicare in which 90% of the patients did not qualify for home health benefits. One day later, on December 1, 2021, the U.S. Attorney’s Office for the Western District of Pennsylvania announced sixty-five months of imprisonment and restitution to the Pennsylvania Medicaid program in the amount of $445,131.67[4] for an individual participating in a scheme to submit fraudulent claims for home health services that were never provided, or for which there was insufficient documentation to support the claims.
How Frier Levitt Can Help
As the demand for home health services increases, providers should anticipate a corresponding increase in the scrutiny of claims. Frier Levitt attorneys are experienced in the representation of providers facing audits or allegations that may lead to FCA liability. Home health providers are well-advised to implement proactive compliance programs and corrective action plans for identified deficiencies. In certain qualifying circumstances, voluntary self-disclosure may be an option for avoiding the harshest penalties. For more information, contact Frier Levitt to speak with an attorney.
[1] Hyperlink to Home health agency to pay $4.2 million to settle False Claims Act allegations | USAO-NDGA | Department of Justice
[2] See 42 C.F.R. § 424.22(a),(b).
[3] Hyperlink to Chicago Woman Sentenced to 56 months for Home Health Care Fraud | OPA | Department of Justice
[4] Hyperlink to Pittsburgh Resident Sentenced to More Than Five Years in Prison for Conspiracy, Health Care Fraud, and Aggravated Identity Theft | USAO-WDPA | Department of Justice
