A home health services company headquartered in Kentucky, and its related entities, paid $2.1 million to the United States government to settle claims of improperly billing the Medicare Program for home health services provided to beneficiaries living in Florida.
According to a complaint filed in the United States District Court for the Southern District of Florida, it was alleged that between 2013 and 2017 the company knowingly submitted false or fraudulent claims seeking payment from the Medicare Program for home health services to Medicare beneficiaries who were not homebound, and who did not require certain skilled care. The complaint also alleged that the company did not have valid or otherwise appropriate plans of care in place, and did not have appropriate face-to-face encounters needed in order to be appropriately certified to receive home health services.
The allegations stem from a complaint to the Department of Health and Human Services, Office of Inspector General (HHS-OIG) complaint hotline and from a complaint for monetary damages under the qui tam provisions of the federal False Claims Act.
Juan Antonio Gonzalez, US Attorney for the Southern District of Florida, stated, “The fraudulent billing of Medicare will not be tolerated. We will continue to aggressively pursue cases against those who erode the fabric of our federal healthcare programs by submitting false claims to Medicare.”
Issue:
All submitted claims must be accurate and truthful. It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Under the civil False Claims Act (FCA), no specific intent to defraud is required. The civil FCA defines “knowing” to include not only actual knowledge but also instances in which the person acted in deliberate ignorance or reckless disregard of the truth or falsity of the information. Further, the civil FCA contains a whistleblower provision that allows a private individual to file a lawsuit on behalf of the United States and entitles that whistleblower to a percentage of any recoveries.
Discussion Points:
- Review your policies and procedures for operating an effective compliance and ethics program to ensure that identifying and reporting of false claims is included. Ensure that your policies are reviewed at least annually and updated when new information becomes available.
- Train all staff on your compliance and ethics policies and procedures upon hire and at least annually. Additionally train all staff on what can be considered a false claim. Document that these trainings occurred and file the signed document in each employee’s education file.
- Periodically perform audits to ensure all staff are aware of compliance and ethics concerns and understand their responsibility to report any concerns of compliance and ethics violations to their supervisor, the compliance and ethics officer, or via the anonymous hotline.
