Amedisys Inc., a Louisiana-based for-profit company and one of the nation’s largest providers of home health services, has agreed to pay $150 million to the federal government to resolve allegations that they violated the False Claims Act by submitting false home healthcare billings to the Medicare program.
The settlement announced today resolves allegations that, between 2008 and 2010, certain Amedisys offices improperly billed Medicare for ineligible patients and services. Amedisys allegedly billed Medicare for nursing and therapy services that were medically unnecessary or provided to patients who were not homebound, and otherwise misrepresented patients’ conditions to increase its Medicare payments. These billing violations were the alleged result of management pressure on nurses and therapists to provide care based on the financial benefits to Amedisys, rather than the needs of patients.
Additionally, this settlement resolves certain allegations that Amedisys maintained improper financial relationships with referring physicians. The Anti-Kickback Statute and the Stark Statute restrict the financial relationships that home healthcare providers may have with doctors who refer patients to them. The United States alleged that Amedisys’ financial relationship with a private oncology practice in Georgia – whereby Amedisys employees provided patient care coordination services to the oncology practice at below-market prices – violated statutory requirements.
“Combating Medicare fraud and overbilling is a priority for my office, other components of the Department of Health and Human Services, and United States Attorneys’ Offices across the country,” said Zane David Memeger, United States Attorney for the Eastern District of Pennsylvania. “We have recovered billions of dollars in federal health care funds from schemes such as the one alleged in this case. Those are health care dollars that should be spent on legitimate medical needs.”
“Home health services are a large and growing part of our federal health care system,” said Sally Quillian Yates, United States Attorney for the Northern District of Georgia. “Health care dollars must be reserved to pay for services needed by patients, not to enrich providers who are bilking the system.”
Amedisys also agreed to be bound by the terms of a Corporate Integrity Agreement with the Office of Inspector General that requires the companies to implement compliance measures designed to avoid or promptly detect and correct improper billing practices and other compliance issues.
Mandatory facts:
1. Defendant/respondent: Amedisys Inc.
2. Exact criminal charges: Violated the False Claims Act by submitting false home healthcare billings to the Medicare program.
3. City and state: Louisiana
4. Exact date: Not specified.
5. Sentence or outcome: Amedisys Inc. agreed to pay $150 million to the federal government.
6. Dollar amounts: $150 million
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Key Facts
- State: Louisiana
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
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