HOSPICE AND HOME HEALTH
DA TE
ENTITY
FCA ALLEGATIONS
AMOUNT
Home health company operator agreed to pay $17 million to resolve FCA allegations that it purchased two home health agencies to obtain referrals of Medicare beneficiaries from other retirement communities operated by the seller of the home health agencies, in violation of the AKS. 22 Two home health service providers agreed to pay $8.5 million to resolve FCA allegations that they submitted claims to Medicare for medically unnecessary or unreasonable laboratory and diagnostic testing services. 23 Home health agency, affiliated physical therapy provider and their owner agreed to pay $450,000 to resolve FCA allegations that they submitted fraudulent claims to Medicare for: (1) therapy services that were not actually provided; (2) services provided by an employee who was actually on maternity leave at the time; (3) services provided to homebound beneficiaries by an unqualified social worker; and (4) claims for which they altered the dates of physician signatures on certifications of beneficiary eligibility for home health services. In September 2021, the former office manager of the physical therapy provider entity, Daniel R. McGoran, agreed to pay more than $75,000 to resolve allegations related to his role in the alleged scheme. 24 Home health agency and its affiliated entities agreed to pay $4.2 million to resolve FCA allegations that they improperly billed Medicare and Medicaid for home health services that were not eligible for reimbursement because, among other things, they did not have the required face-to-face certifications or plans of care, and they did not document the beneficiary’s homebound status or need for the home health services. The settlement also resolves allegations that PruittHealth became aware of payments for home health services to which it was not entitled, but failed to disclose or refund the overpayments in a timely manner. 25
BAYADA Home Health Care Inc.; BAYADA Health LLC; BAYADA Home Care; BAYADA
9/8/2021
$17 million
U.S. Medical Management, LLC; VPA, P.C.
10/8/2021
$8.5 million
Great Lakes Home Healthcare Specialists, LLC; Great Lakes Therapy Housecalls, P.C.; James A. Harvey
$450,000
11/3/2021
PruittHealth, Inc.
$4.2 million
11/22/2021
Carrefour Associates LLC; Crossroads Hospice of Cincinnati LLC; Crossroads Hospice of Cleveland LLC; Crossroads Hospice of Dayton LLC; Crossroads Hospice of Northeast Ohio LLC; Crossroads Hospice of Tennessee LLC
Hospice chain agreed to pay $5.5 million to resolve FCA allegations that it billed Medicare for hospice services provided to patients with Alzheimer’s or dementia who were not terminally ill. 26
11/23/2021
$5.5 million
22 https://www.justice.gov/usao-nj/pr/home-health-agency-operator-pay-17-million-resolve-false-claims-act-kickback-allegations. 23 https://www.justice.gov/usao-edmi/pr/usmm-and-vpa-pay-85-million-resolve-overpayment-medicare-claims-laboratory-and. 24 https://www.justice.gov/Usao-wdmi/pr/2021_1103_Harvey. 25 https://www.justice.gov/usao-ndga/pr/home-health-agency-pay-42-million-settle-false-claims-act-allegations-0. 26 https://www.justice.gov/opa/pr/crossroads-hospice-agrees-pay-55-million-settle-false-claims-act-liability.
NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 48
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