Tenn. Home Health Care Provider to Pay $9.4 Million Settlement for Overbilling Medicare

CareAll Management LLC, a home health care provider based in Nashville, Tenn., has agreed to pay the federal government $9.375 million to settle a lawsuit filed by the United States in 2009 alleging that the company and several related entities violated the False Claims Act by over-billing Medicare, announced the Department of Justice.

The home health care company, formerly known as Diversified Health Management, was named in the suit along with Care All Inc., the James W. Carell Family Trust, James W. Carell, VIP Home Nursing and Rehabilitation Services LLC, Professional Home Health Care LLC, University Home Health, LLC, and Elizabeth Vining (as a representative of the estate of Robert Vining) for becoming “unjustly enriched” by falsely concealing the home health agencies’ relationship with their management company. 

The VIP, Professional, and University home health care agencies now operate under the name CareAll. James Carell and the related CareAll entities also agreed to be bound by the terms of a Corporate Integrity Agreement with the Department of Health and Human Services – Office of Inspector General. 

CareAll and its related entities is one of the largest home health providers in Tennessee, says the DOJ. The United States’ lawsuit against the provider alleged that the entities fraudulently submitted eight cost reports for fiscal years 1999, 2000, and 2001 to support their Medicare billings, and these cost reports were false because the entities had knowingly hid the relationship between the management company and the home health agencies.

The cost reports should have disclosed the relationship, according to the complaint filed by the United States, and this would have lowered the Medicare reimbursement for the management company’s services. 

During that three-year time period, Carell owned the management company, while his friend, Robert Vining, served as the “sham” owner of the home health agencies, the U.S. alleged in the court filing. This allowed Carell to profit “greatly” from this “sham” owner relationship, says the DOJ, and Vining was monetarily rewarded for his participation in the scheme. 

“The false reporting scheme alleged in this case robbed the Medicare Trust Fund of millions of taxpayer dollars,” said Stuart Delery, Acting Assistant Attorney General for the Civil Division of the Department of Justice.  “Settlements like this one make sure that our federal health care dollars are spent appropriately – on maintaining critical health care programs.”

Written by Alyssa Gerace

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