HOSPICE AND HOME HEALTH
DA TE
ENTITY
FCA ALLEGATIONS
AMOUNT
Hospice provider, home health provider and their owners agreed to pay more than $1.8 million to resolve FCA allegations that they submitted claims to Medicare that were tainted by improper compensation arrangements and referral relationships, in violation of the AKS and Stark Law. The providers allegedly paid referral sources above FMV for medical directorship services and provided physicians other gifts and benefits, including travel and sporting event tickets. Allstate also sold interests in the company to five different physicians which ultimately netted them substantial quarterly dividends. 17 Pediatric home health provider agreed to pay almost $275,000 to resolve self-disclosed CMPL allegations that it submitted claims to two state Medicaid programs for services provided by individuals who were either excluded or did not have a valid Medicaid provider agreement. 18 Home health provider and its owner/CEO agreed to pay $28,246 to resolve allegations that they employed a physical therapist who was excluded from participation in all federal healthcare programs. The physical therapist was excluded from all federal healthcare programs in 2015 after he defaulted on his obligations under an Integrity Agreement (IA) with HHS-OIG. 19 Home health provider and its owners agreed to pay more than $300,000 to resolve allegations that they submitted claims to the Missouri Medicaid program that billed for more hours than were actually spent providing care to beneficiaries and that they intentionally altered timesheets and other records. As part of the resolution, the company agreed to submit a corrective action plan and be subject to a one-year provider enrollment agreement. 20 Home health provider and its owner agreed to pay $2.9 million to resolve state and federal FCA allegations that they billed Oregon Medicaid for in-home care that was not actually provided. The company also pleaded guilty to two counts of making a false claim for healthcare payment. As part of the resolution, AHCG and its owner were excluded from participating in Medicare, Medicaid and all other federal healthcare programs for 15 and 8 years, respectively. 21
Allstate Hospice LLC; Verge Home Care LLC; Onder Ari; Sedat Necipoglu
1/19/2021
$1.847 million
Pediatric Services of America, Inc.
3/10/2021
$274,753
CareCo Medical, Inc.; Helga Pfanner
4/12/2021
$28,246
Healthy Home & Family, Inc.; Belinda Bivens; Mary Stockson
$302,127
5/4/2021
At Home Care LLC d/b/a At Home Care Group; Kevin Cox
8/26/2021
$2.9 million
17 https://www.justice.gov/usao-sdtx/pr/hospice-home-health-agency-and-owners-pay-over-18m-resolve-claims-concerning-physician. 18 https://oig.hhs.gov/fraud/enforcement/pediatric-services-of-america-agreed-to-pay-274000-for-allegedly-violating-the-civil-monetary-penalties-law-by-employing-an-excluded-individual-and-submitting-claims-for-services- provided-by-an-individual-without-a-valid-provider-agreement/. 19 https://www.justice.gov/usao-ct/pr/home-health-company-pays-28k-employing-excluded-individual. 20 https://ago.mo.gov/home/news/2021/05/04/missouri-attorney-general-obtains-$300-000-settlement-in-medicaid-fraud-case. 21 https://www.justice.gov/usao-or/pr/bend-resident-and-affiliated-residential-care-company-agree-pay-29-million-settle-health.
NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 47
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