Home Health and Hospice Archives - Page 18 of 24

October 1, 2015

Nurses’ Registry and Home Health Corporation and the Estate of its former owner, the deceased Lennie House, agreed to pay $16 million to resolve allegations that Nurses’ Registry, at the direction of Lennie House, violated the False Claims Act by fraudulently billing Medicare for medically unnecessary home health services and for services tainted by kickbacks provided by the company and House to local physicians and others who referred patients to Nurses’ Registry. According to the government, Nurses’ Registry falsified medical records to make it appear as if patients had a medical need for skilled nursing or therapy services, or appear as if the patients were homebound. In addition to billing Medicare for unnecessary or non-reimbursable home health services, Nurses’ Registry and House provided tickets to athletic events and concerts, and provided other things of value, to doctors and referral sources in order to induce or reward patient referrals. The allegations originated in a whistleblower lawsuit filed by former employees Alisia Robinson-Hill and David Price under thequi tam provisions of the False Claims Act. They will receive a yet-to-be-determined whistleblower award from the settlement proceeds. DOJ (KY)

Tagged in: Anti-Kickback and Stark, FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

September 10, 2015

Tennessee-based non-profit hospice care provider Alive Hospice, Inc.paid roughly $1.5 million to reimburse the government for alleged violations of the False Claims Act through overbilling of Medicare and TennCare for hospice services. According to the government, Alive submitted claims to Medicare and TennCare for general inpatient hospice care for patients who did not qualify for that care. The allegations originated in a whistleblower lawsuit filed by Linda Anderson, a triage nurse who previously worked for Alive, under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of $263,197. Whistleblower Insider

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

September 4, 2015

Rick Brown, former president of Home Care America Inc., which managed the daily business operations of Medicall Physicians Group Ltd., was sentenced to 87 months in prison and to pay $1.3 million in restitution for his role in a $4 million health care fraud scheme. Medicall is a physician practice that visited patients in their homes and prescribed home health care. The evidence at trial showed that Brown and his co-conspirators routinely billed Medicare for overseeing patient care plans when in fact the doctors at Medicall rarely did so. The evidence also showed that Brown and his co-conspirators billed Medicare for services never provided, including services rendered to patients who were deceased, services purportedly provided by medical professionals no longer employed by Medicall, and services purportedly provided by medical professionals who, based on billing records, worked over 24 hours per day. DOJ

Tagged in: Home Health and Hospice, Medical Billing Fraud, Medicare,

September 3, 2015

St. Joseph Hospice Entities, which consists of 13 hospice facilities in Mississippi, Louisiana, Texas and Alabama, and Patrick T. Mitchell, its majority owner and manager, agreed to pay $5,867,518 to resolve allegations they violated the False Claims Act by submitting false claims for delivery of continuous home care hospice services to patients who were not entitled to receive them. The allegations originated in a whistleblower lawsuit filed by 3 former employees of the company under the qui tam provisions of the False Claims Act. They will receive a whistleblower award of roughly $1 million. DOJ

Tagged in: FCA Federal, Home Health and Hospice, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

July 27, 2015

Zafar Mehmood and Badar Ahmadani, owners of two home health care agencies, were convicted of various offenses based on their roles in a $33 million Medicare fraud scheme. According to evidence presented at trial, Mehmood and Ahmadani paid cash kickbacks to recruiters, who in turn paid cash to patients to induce them to sign up for home health care with Mehmood’s companies: Access Care Home Care Inc., Patient Care Home Care Inc., Hands On Healing Home Care Inc. and All State Home Care Inc. The evidence also showed that the defendants paid kickbacks to physicians to refer patients to the defendants’ companies for unnecessary home health care services. DOJ

Tagged in: Anti-Kickback and Stark, Home Health and Hospice,

June 18, 2015

Non-profit hospice care provider Covenant Hospice Inc. agreed to pay $10,149,374 to reimburse the government for alleged overbilling of Medicare, Tricare and Medicaid for hospice services. According to the government, Covenant Hospice improperly submitted hospice claims for general inpatient care that should have been billed at the routine home care level. The government further alleged that Covenant Hospice’s medical records did not support the medical necessity of the general inpatient care. DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Upcoding,

June 16, 2015

Jacksonville, Florida-based home health company Advanced Homecare, Inc.agreed to pay $1,293,169 to settle charges it violated the False Claims Act by billing the government for millions of dollars of medically unnecessary services. According to the government, Advanced Homecare accepted and treated patients who were not actually homebound and did not have a valid physician certification of home health need, as required by Medicare. The allegations first arose in a whistleblower lawsuit filed by Advanced Homecare former employee Marsha Yandell under the qui tam provisions of the False Claims Act. Ms. Yandell will receive a whistleblower award of more than $200,000. DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

June 1, 2015

A group of home health care companies collectively known as “Friendship” and the companies’ owner Theophilus Egbujor agreed to pay $6.5 million to resolve allegations they improperly billed TennCare, Medicare and TRICARE for home health services. Specifically, the government claimed Friendship billed TennCare for private duty nursing services that were furnished or supervised by a woman who was excluded from billing federal and state health care programs and that Friendship submitted required forms to TennCare that contained the forged signature of Friendship’s Director of Nursing. The specific entities included in the settlement agreement are Friendship Home Healthcare, Inc., which has also done business as Friendship HealthCare System; Friendship Home Health, Inc., and Angel Private Duty and Home Health, which have also done business as Friendship Private Duty; and Friendship Home Health Agency, LLC. The allegations first arose in a whistleblower lawsuit filed by Kay Flippo, a licensed practical nurse who previously worked for Friendship Home Healthcare, under the qui tam provisions of the False Claims Act. She will receive a yet-to-be determined whistleblower award. DOJ

Tagged in: FCA Federal, FCA State, Home Health and Hospice, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 23, 2015

Louisiana doctor Winston Murray pleaded guilty to federal health care fraud charges, admitting (i) he wrote home health care referrals for Medicare beneficiaries he knew were not confined to their homes, and (ii) his referrals were used by home health companies Interlink Health Care Services Inc. and Lakeland Health Care Services Inc., among others, to fraudulently bill Medicare for home health services not medically needed or not provided. From 2007 through 2014, these companies and other companies involved in this scheme submitted more than $56 million in claims to Medicare, a vast majority of which were fraudulent. DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

April 16, 2015

Felix Gonzalez, owner of Miami home health care company AA Advanced Care Inc. was ordered to pay $21,423,160 in restitution and sentenced to 113 months in prison in connection with a $32 million Medicare fraud scheme. Gonzalez admitted operating his company for the purpose of billing the Medicare program for expensive physical therapy and home health care services that were not medically necessary or provided at all. He further admitted he negotiated and paid kickbacks and bribes to patient recruiters in exchange for patient referrals, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud,

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