A whistleblower lawsuit brought under the federal False Claims Act has resulted in a government recovery from one of the largest home health agencies. In April 2014, the Department of Justice announced that the home health agency Amedisys, Inc. and its affiliates agreed to pay $150 million to settle a whistleblower lawsuit alleging federal False Claims Act violations by submitting fraudulent claims for the provision of home health services.
Specifically, the settlement covers claims that between 2008 and 2010, some of Amedisys’ offices billed Medicare for ineligible services and patients.
Seven whistleblowers filed qui tam lawsuits against Amedisys. This settlement resolves claims asserted in all seven. The settlement resulted in a whistleblower award of over $26,000,000, which will be split among all seven whistleblowers. The seven whistleblowers asserted a variety of home health fraud claims under the federal False Claims Act against the home health provider.
First, a whistleblower alleged that their Amedisys office provided home services to patients who were not homebound. Per Medicare’s regulation, Medicare only covers home health services for patients who, among other things, are homebound. A patient who is not homebound is therefore ineligible to receive home health services covered by Medicare. Rather, as the whistleblower alleged, Amedisys disregarded their patients’ true conditions to maximize profits.
A second whistleblower alleged that Amedisys manipulated the number of therapy visits it would provide patients in order to maximize its Medicare reimbursement. Medicare gives “bonus” payments when home health agencies provide a patient with six, fourteen, and twenty therapy sessions during a given 60-day episode. The whistleblower alleged that managers at certain Amedisys offices would pressure its staff to increase patients therapy visits to ensure as many patients as possible resulted in a Medicare therapy bonus payment.
This settlement also settles allegations by a whistleblower of the federal Anti-Kickback Statute and Stark Law violations. The Anti-Kickback Statute and the Stark Statute restrict certain financial relationships that home health care agencies may have with referring doctors. The Anti-Kickback Statute whistleblower alleged that an Amedisys office provided health services to an oncology practice at below market prices in order to unlawfully induce the referrals of their Medicare patients.
Amedisys also agreed to be bound by the terms of a Corporate Integrity Agreement with the Department of Health and Human Services that requires it to implement compliance measures designed to avoid or promptly detect similar conduct.
The lawsuits are captioned United States ex rel. CAF Partners et al. v. Amedisys, Inc. et al. 10-cv-2323 (E.D. Pa.); United States ex rel. Brown v. Amedisys, Inc. et al., 13-cv-2803 (E.D. Pa.); United States ex rel. Umberhandt v. Amedisys, Inc., 13-cv-2789 (E.D. Pa.); United States ex rel. Doe et al. v. Amedisys, Inc., 13-cv-3187 (E.D. Pa.); United States ex rel. Ognen et al. v. Amedisys, Inc. et al. 13-cv-4232 (E.D. Pa.); United States ex rel. Lewis v. Amedisys, Inc., 13-cv-3359 (E.D. Pa.); and United States ex rel. Natalie Raven et al. v. Amedisys, Inc. et al., 11-cv-0994 (N.D. Ga.). The claims settled by the agreement are allegations only, and there has been no determination of liability.
No Fees Without Recovery
Ross M. Wolfe and the Weiser Law Firm litigate whistleblower lawsuits on a contingent fee basis, so whistleblowers do not pay attorneys’ fees or court costs unless there is a recovery.
Please contact Ross M. Wolfe if you would like to speak with a whistleblower attorney for more information about the whistleblower process, home health fraud or to schedule a meeting to discuss your potential case.