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Crime Pays: $25 Million Down the Drain
CareAll Management LLC, a Nashville-based home healthcare provider, has agreed to pay $25 million to settle allegations of submitting false and upcoded home healthcare billings to the Medicare and Medicaid programs. The scam, which took place between 2006 and 2013, involved overstating the severity of patients’ conditions to increase billings and billing for services that were not medically necessary and rendered to patients who were not homebound.
“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 Justice Department’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.”
The settlement resolves allegations that CareAll, one of Tennessee’s largest home health providers, engaged in a scheme to defraud the government. 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 settlement announced today, 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.”
The relator in this case, Toney Gonzales, will receive more than $3.9 million as his share of the recovery. Under the False Claims Act, private citizens, known as relators, can bring suit on behalf of the United States and share in any recovery.
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of HHS. Since January 2009, the Justice Department has recovered a total of more than $23.1 billion through False Claims Act cases, with more than $14.8 billion of that amount recovered in cases involving fraud against federal health care programs.
The settlement was the result of a coordinated effort by the Civil Division, the U.S. Attorney’s Office for the Middle District of Tennessee, HHS-OIG and the Tennessee Bureau of Investigation. The case is docketed as United States ex rel. Gonzales v. J.W. Carell Enterprises, Inc., et al., No. 12-0389 (M.D. Tenn.). The claims resolved by the settlement are allegations only; there has been no determination of liability.
Key Facts
- State: Tennessee
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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