Three home healthcare agencies, along with their corporate owner, have agreed to pay nearly $4.5 million to settle allegations they violated the False Claims Act.
The Allegations
It was alleged that between 2013 and 2022 Guardian Health Care Inc., Gem City Home Care LLC and Care Connection of Cincinnati LLC — operating in Texas, Ohio and Indiana — along with their owner Dallas-based Evolution Health LLC provided lease payments, wellness-related activities, first aid, and preventive health services, sports tickets, meals, and other valuable benefits, to the staff and residents of 46 assisted living facilities and to 15 referring healthcare providers. Medicare coverage of home health services requires physician certification of the beneficiary’s eligibility for the home health benefit.
In exchange, in violation of the false claims act, the accused companies received referrals of the assisted living facilities’ residents and the referring healthcare providers’ patients to the accused for home health services.
The Anti-Kickback Statute
The Anti-Kickback Statute prohibits the provision of remuneration with the intent to induce referrals of government health care program business. The Anti-Kickback Statute is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives. Claims that are knowingly submitted in violation of the Anti-Kickback Statute are ineligible for payment and can violate the False Claims Act.
Self-Disclosure Pays Off
On the plus side, the allegations came to the attention of authorities via self-disclosure in March 2022. The companies stopped the illegal practice, collected all documents relevant to the questionable conduct, filed a supplemental disclosure and cooperated with the government’s investigation and identified those involved, according to the settlement agreement. Self-disclosure is a mitigating factor and received credit as a result.
The companies were acquired by Amedisys, Inc. in April 2022.
Punishment Under the False Claims Act
The False Claims Act imposes triple damages and penalties on those who knowingly and falsely claim money from the United States or knowingly fail to pay money owed to the United States. These recoveries restore funds to federal programs such as Medicare, Medicaid, and TRICARE, the healthcare program for service members and their families.
As we wrote about earlier this year, false claims act settlements and judgments exceed $2.68 billion in fiscal year 2023.
Home Healthcare Ripe for Fraud
The home healthcare sector is a growing one. According to the National Center for Health Statistics there are 11,400 home health agencies in the U.S. with approximately 3 million Medicare Fee for Service (FFS) beneficiaries using them. In 2020, 8.3% of all Medicare FFS beneficiaries utilized home health care.
Spending for services provided by freestanding home healthcare agencies increased 6.0 percent in 2022 to $132.9 billion, accelerating from growth of 0.3 percent in 2021. It’s also one of the areas with large-scale fraudulent activities.
Most home healthcare fraud involves home health agencies violating the false claims act by billing for services that were not provided, billing for services that were not medically necessary, or engaging in kickback schemes to generate referrals.
This most recent case further illustrates the federal government’s commitment to taking a deep dive into home health billing practices nationwide.
How We Can Help
The Health Law Offices of Anthony C. Vitale can assist with all aspects of home health compliance and defense services including audits, overpayments and compliance programs. We can provide the support and guidance you need to protect your practice, your reputation, and maintain your professional integrity.
Give us a call at 305-358-4500 or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.
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