The largest home health care fraud settlement in the history of the False Claims Act was announced by the DOJ. Amedisys, Inc. (Amedisys) agreed in April 2014 to pay a $150 million home health care fraud settlement. The settlement resolved claims brought by our client under the federal False Claims Act. In addition, Amedisys entered into a Corporate Integrity Agreement with the Office of HHS-OIG.
This settlement marked the successful conclusion of a lengthy effort by our client, relator CAF Partners (a partnership of individuals), to expose Amedisys’ fraudulent home health care practices.
Home health care is provided by a professional caregiver to a patient in an individual home, as opposed to care provided in group homes like nursing homes. In order to be eligible for reimbursement from Medicare for the provision of home health care services, a physician must certify that 1) home health care services are medically necessary; 2) the patient’s condition will likely improve with home health care, or home health care will prevent further deterioration of the patient’s condition; and 3) the patient is homebound.
Our client alleged that Amedisys systematically manipulated data to make patients appear sicker than they actually were in order to justify extra, unnecessary therapy visits to qualify for bonus payments under the Medicare Home Health Prospective Payment System (PPS). Amedisys’ proprietary software system admitted, and subsequently recertified, Medicare patients for home health care when they did not meet the Medicare guidelines for services. Amedisys also targeted Medicare patients for recertification in order to qualify for higher reimbursement rates from Medicare.
Our client brought Amedisys’ fraud to the attention of the government by filing a qui tam complaint under the False Claims Act. Under the False Claims Act, a private citizen (known as a “relator”) who suspects or knows of fraud against the government can act as a whistleblower and file a sealed complaint on behalf of the government. If the case is successful, the relator is entitled to a share – between 15% and 30% – of the government’s recovery.
We were assisted in this case by Kenney & McCafferty. We filed the whistleblower case in the Eastern District of Pennsylvania. United States ex rel. CAF Partners v. Amedisys, et al., Civ. No.:10-cv-02323 (E.D. PA)
The Whistleblower Law Collaborative LLC, based in Boston, devotes its practice entirely to representing clients in bringing actions under the federal and state False Claims Acts and other whistleblower programs. Under the False Claims Act, a private citizen (known as a “relator”) who suspects or knows of fraud against the government can act as a whistleblower and file a sealed complaint on behalf of the government. If the case is successful, the relator is entitled to a share of the government’s recovery. Among the firm’s many successes is the government’s $885 million settlement with AmerisourceBergen, a pharmaceutical drug wholesaler, for illegal repackaging of injectable drugs into pre-filled syringes.
For more information, contact the Whistleblower Law Collaborative LLC at 617.366. 2800