Agency Faces $21 Million Penalty for ‘Extreme’ Medicare Fraud

A home care company with operations in five U.S. states has agreed to pay the federal government millions after admitting to fraudulent billing practices so widespread, the government called the company an “extreme outlier.”

Kentucky-based MD2U Holding Company has admitted to violating the False Claims Act and is now liable to the United States in the amount of about $21.5 million, the U.S. Department of Justice (DOJ) announced Thursday.

Almost all—98%—of Medicare claims MD2U submitted between July 1, 2007, and Nov. 30, 2014, were falsely billed to Medicare, the DOJ found.

In a review of MD2U’s activity during that same period, the federal government determined that the home care company submitted fraudulent bills for patients who were not homebound; billed government health care programs at the highest payment codes when a lower code would have been more applicable; wrongly billed the government for visits that were medically unnecessary; and cloned medical records as a means of justifying patient visits.

Patient visits conducted by MD2U’s non-physician providers, for instance, would often last under 10 minutes, with some lasting less than five minutes. Even so, these encounters were billed as comprehensive medical visits and billed at the highest level evaluation and management (E&M) code possible, DOJ said.

Additionally, MD2U used an electronic medical record (EMR) system that enabled its non-physician practitioners to electronically cut, copy and paste medical notes from previous visits, DOJ found.

“This provider billed for medically unnecessary home visits and often grossly exaggerated the level of service provided,” said Special Agent in Charge Derrick L. Jackson for the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) in Atlanta.

In a formal complaint, the DOJ called MD2U “an extreme outlier in its frequency of billing the highest level E&M [Physicians Current Procedural Terminology] codes when compared to other Medicare providers in Kentucky, the states in which it operates, or nationally.”

The government has said that MD2U and its owners—President and CEO J. Michael Benfield, Chief Information Officer Greg Latta and Chief Operations Officer Karen Latta—can fulfill their obligations to pay the consent judgment by paying $3.3 million and a percentage of MD2U’s net income throughout the next five years. Additionally, the company and its owners have promised to enter into a five-year corporate integrity agreement with the U.S. Department of Health and Human Services’ Office of Inspector General.

MD2U home care workers serve patients in several counties in Kentucky, Florida, Indiana, Ohio and North Carolina.

Written by Mary Kate Nelson