To resolve allegations that it violated the False Claims Act by submitting false home health care billings to Medicare and Medicaid, ResCare Iowa Inc. has agreed to settle for $5.63 million, the Department of Justice (DOJ) announced this week.
The disputed billings mainly related to the requirement that doctors conduct face-to-face assessments of potential home health patients, and document these encounters.
The company, a subsidiary of Louisville, Kentucky-based ResCare Inc., provides home health care services to patients in the state of Iowa. Its settlement is part of a larger initiative launched by the U.S. government to combat health care fraud.
According to the rules of both Medicare and the state of Iowa’s Medicaid program, an independent physician must certify that home health care services are medically necessary and must order the specific type and amount of health care services to be provided by the home health agency.
Additionally, Medicare and Iowa Medicaid rules require these independent physicians to perform an in-person assessment of each patient before the home health agency can bill the government for any services.
However, according to the DOJ, between 2009 and 2014, ResCare Iowa billed the government for services provided to Medicare and Medicaid patients in Iowa without documenting compliance with state and federal requirements.
“We commenced this investigation due to concerns that this provider was not complying with the rules and was not submitting accurate claims for payment,” said U.S. Attorney Kevin W. Techau, of the Northern District of Iowa. “When the government pays for home-based medical services, we are dedicated to ensuring the money is well-spent and medically deserving patients receive the care to which they are entitled.”
As part of the settlement, the state of Iowa, which paid part of the Medicaid funds at issue, will receive $2.32 million.
ResCare self-disclosed the documentation issues to the government after they were discovered by an outside auditor, ResCare spokeswoman Nel Taylor wrote in an email to the DesMoines Register. The provider’s quality of care never was questioned, she emphasized.
Written by Emily Study