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Home Health and Hospice

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Top Takeaways from Former DOJ Civil Chief Jody Hunt on the Current State of False Claims Act Enforcement

Posted  08/28/20
department of justice website
Law360 recently interviewed former DOJ Civil Chief Jody Hunt on what he sees as the key issues surrounding False Claims Act enforcement these days.  Here are the top takeaways:
    • COVID-relief fraud will be a DOJ priority. No surprise there given the billions of dollars the federal government is pouring into the economy to alleviate some of the financial strain the pandemic is wreaking on healthcare providers...

August 19, 2020

Metropolitan Jewish Health System Hospice and Palliative Care agreed to pay a total of $5.225 million resolve civil allegations that it billed Medicare and Medicaid for services rendered to hospice patients at heightened levels of care for which the patients did not qualify, in violation of the False Claims Act. A government investigation following the filing of a whistleblower complaint determined that defendant falsely claimed that some of its patients required heightened “continuous home care services” and “general inpatient services,” thereby entitling the defendant to artificially inflated reimbursements.  USAO ED NY

OIG Audit Suggests Home Health Agencies Submit Unsupported Visits to Trigger Higher Medicare Reimbursement

Posted  07/31/20
visiting nurse with elder woman sitting on a couch
OIG released results from its targeted audit of certain home health care claims submitted for payment and found $191.8 million of overpayments in 2017 alone. OIG's objective was to determine whether payments for home health services with five to seven visits in a payment episode complied with Medicare requirements. During the 2017 audit period, under Medicare's home health prospective payment system, home health...

July 8, 2020

A Florida-based nonprofit that provides hospice care, palliative care, and other services to the elderly, has agreed to pay $3.2 million to resolve its liability under the False Claims Act.  According to former Director of Hospice Care, Margaret Peters, Hope Hospice knowingly submitted false claims to Medicare, Medicaid, and TRICARE for medically unnecessary but highly reimbursed general inpatient (GIP) hospice services over a five year period.  For blowing the whistle on the alleged fraud, Peters will receive a 19% share of the settlement.  USAO MDFL

Visiting Nurse Service of New York – Medicare/Medicaid Home Health Care Fraud ($57 million)

Constantine Cannon represented whistleblower Edward Lacey against Visiting Nurse Service of New York – the largest not-for-profit home health care agency in the United States.  VNSNY agreed to pay $57 million to resolve allegations it failed to provide home health care visits and services to tens of thousands of New Yorkers and fraudulently billed Medicare and Medicaid.  Mr. Lacey was an executive at VNSNY for 16 years.  In his complaint, Mr. Lacey alleged that VNSNY failed to provide its patients all the critical nursing and therapy visits and services their doctors prescribed under the patient Plans of Care.  He contended that by failing to provide this care, VNSNY endangered the welfare of tens of thousands of its patients while maximizing the company's Medicare and Medicaid reimbursement.  Mr. Lacey's claims concerning alleged Plan of Care failures impact the entire home health care industry.  This is the first reported False Claims Act settlement involving allegations of a home health agency failing to follow patient Plans of Care.  It also is the largest non-kickback False Claims Act settlement ever against a home health care company and the second largest settlement of any home health care fraud case.  Read more: Press Release; Whistleblower Insider.

Press Round-Up: Settlement in Visiting Nurse Service of New York Case Described as Groundbreaking

Posted  07/2/20
Newsboy hawking paper
The record-setting $57 million settlement in U.S. ex rel. Lacey v. Visiting Nurse Service of New York, a False Claims Act case brought by Constantine Cannon client Edward Lacey, received extensive coverage in the media, with stories noting that the wrongdoing alleged was “pervasive” in the home health industry. As a whistleblower, Lacey alleged that home health agency VNSNY failed to adhere to the plans of care...

Visiting Nurse Service of New York Settles Whistleblower Case Brought by Constantine Cannon Client for $57 Million

Posted  06/26/20
hand holding hospice patients hand
Constantine Cannon is pleased to announce a $57 million settlement of the False Claims Act lawsuit its whistleblower client brought against the Visiting Nurse Service of New York (VNSNY).  VNSNY is the largest not-for-profit home health care agency in the country, serving roughly 150,000 patients a year in New York, most of whom are elderly and/or disabled. The whistleblower, Edward Lacey, was an executive at...

“Objective Falsity” Is Not Required Under the False Claims Act: A Legally False Opinion May Suffice

Posted  03/6/20
Gavel close-up
In a significant win for whistleblowers, a federal appellate court held this week that, in order to determine liability under the False Claims Act, a whistleblower need not prove that a claim is “objectively” false.  Instead, the Court held that, consistent with common law, a claim can be false under the FCA if based not on objectively verifiable facts, but on non-compliance with statutory or regulatory...

March 4, 2020

STG Healthcare of Atlanta, Inc. and senior executives Paschal Gilley and Mathew Gilley have agreed to resolve fraud allegations by paying $1.75 million.  The case against the hospice was launched by two former employees, Serita Samuel and Miranda Eskridge, who alleged in a qui tam suit that STG Healthcare submitted false claims to Medicare and Medicaid that arose from illegal payments to so-called back-up medical directors, and that were on behalf of patients who were not terminally ill and thus ineligible for palliative care.  GA AG; USAO NDGA

Catch of the Week: Guardian Elder Care

Posted  02/21/20
person holding elder's hand
This week's DOJ Catch of the Week goes to Guardian Elder Care.  On Wednesday, the operator of more than 50 nursing homes in Pennsylvania, Ohio and West Virginia agreed to pay roughly $15.5 million to resolve allegations it violated the False Claims Act by billing the government -- Medicare and the Federal Employees Health Benefits Program -- for medically unnecessary rehabilitation therapy services.  According to...
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