Self-Disclosure Leads to $4.4 Million Home Health Settlement

A Hancock, Mich.-based hospital has agreed to pay the United States more than $4 million to settle allegations that its home health care agency committed Medicare fraud.

Portage Hospital, LLC, in Hancock, Michigan, agreed to pay $4,446,392.43 due to claims its hospital-owned home health care agency, Portage Health Home Care & Hospice, violated the False Claims Act.

The home and health agency violated the False Claims Act by submitting false claims to Medicare for home health care services purportedly rendered by a staff physical therapist, according to the U.S. Attorney’s Office for the Western District of Michigan.

The settlement stems from a self-disclosure to the U.S. Department of Health & Human Services, Office of Inspector General (HHS-OIG) by Portage Hospital.

Based on information provided by Portage Hospital, now UP Health System Portage, the United States alleged that physical therapy services that the staff therapist provided to Medicare home health care patients between Jan. 1, 2006 and Nov. 30, 2013 were medically unnecessary, lacked adequate documentation of medical necessity, and/or did not qualify for payment by Medicare.

“Self-disclosures by providers are critical to protecting the integrity of federal health care programs,” said U.S. Attorney Patrick A. Miles, Jr. in a statement. 

While the staff therapist claimed to be performing between 1,889 and 3,352 home health care visits each year, his documentation allegedly generally failed to establish, among other things, patients’ homebound status and the need for skilled therapy services.

“A health care provider’s decision to self-disclose its improper behavior benefits both the provider, in this case a hospital, and Federal health care programs, and we will continue to work with our law enforcement partners and providers to reach prompt, appropriate settlement of conduct disclosed in good faith,” said Special Agent in Charge Lamont Pugh III, U.S. Department of Health & Human Services, Office of Inspector General.

This case was investigated by HHS-OIG and the U.S. Attorney’s Office for the Western District of Michigan. Assistant U.S. Attorney Adam B. Townshend represented the United States. 

Written by Cassandra Dowell

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