CareAll Management LLC and its affiliated entities have agreed to pay $25 million, plus interest, to the United States and the state of Tennessee to settle False Claims Act allegations, the Department of Justice (DOJ) announced recently.
The settlement resolves allegations that CareAll — based in Nashville, Tenn., and one of the state’s largest home health providers — violated the Act by submitting false and up coded home health care billings to the Medicare and Medicaid Programs.
Under the False Claims Act, private citizens, known as “relators,” can bring suit on behalf of the United States and share in any recovery. The relator in this case, Toney Gonzales, will receive more than $3.9 million as his share of the recovery.
“Home health agencies may only bill Medicare and Medicaid for care that is necessary and covered by the programs,” said Acting Assistant Attorney General Joyce R. Branda for the DOJ’s Civil Division. “This settlement is another example of the department’s commitment to ensuring that home health care dollars – which are so vital to ensure the care of homebound patients – are spent for their intended purposes.”
This settlement resolves allegations that between 2006 and 2013, CareAll overstated the severity of patients’ conditions to increase billings and billed for services that were not medically necessary and rendered to patients who were not homebound.
This is CareAll’s second settlement of alleged False Claims Act violations within the last two years. In 2012, CareAll paid nearly $9.38 million for allegedly submitting false cost reports to Medicare.
As part of the recent settlement, the companies agreed to be bound by the terms of an enhanced and extended corporate integrity agreement with the Department of Health and Human Services-Office of Inspector General (HHS-OIG) in an effort to avoid future fraud and compliance failures.
“Fraudulent home-based services are surging across the country,” said Special Agent in Charge Derrick L. Jackson of HHS-OIG in Atlanta. “We will continue to protect both Medicare and taxpayers, and ensure that funds are not siphoned off by companies more concerned with the bottom line than patient care.”
Written by Emily Study