February 13, 2017 - Posts

Assistant Inspector General Highlights Widespread Home Health Fraud Against Medicaid

Government health care programs—Medicaid in particular—have long been susceptible to fraud and abuse from home health care providers. On January 31, 2017, Assistant Inspector General Ann Maxwell of HHS OIG testified before a Congressional committee on the scope of that potential fraud and on the serious challenges facing Medicaid as it tries to control home health spending and keep bad actors out of the program.

In her testimony, Assistant Inspector General Maxwell highlighted the fact that many states are not fulfilling their Medicaid obligations with respect to reviewing and monitoring home health and other Medicaid providers.  For example:

• As of 2015, thirty-seven states were still not conducting full criminal background checks on providers, even though Medicaid has required such background checks since 2011; and
• As of 2015, eleven states still were not conducting site visits on Medicaid providers, despite being required to do so.

The Assistant Inspector General also pointed out that due to a quirk in Medicaid law, state fraud control units are allowed to investigate patient abuse and neglect in health care facilities (e.g. hospitals, nursing homes), but cannot investigate abuse or neglect by home health or community health organizations. This has made it far more difficult to successfully prosecute home health agencies for patient abuse and neglect, as well as for the fraudulent billing that often accompanies such abuse and neglect.

Assistant Inspector General Maxwell’s complete testimony before Congress is available here.

Although the Assistant Inspector General’s testimony did not directly address whistleblower lawsuits, her testimony is further evidence of why whistleblowers have such an important role to play in uncovering fraud against the government.  Even under the best of circumstances, the government cannot catch all the bad actors out there, so it is up to public-minded whistleblowers to fill in the gaps and report fraud where and when they find it.

Over the past few years, there have been numerous whistleblower lawsuits against home health companies that have recovered millions of dollars for federal and state governments.

• In 2014, home health company Amedisys Inc. and its affiliates agreed to pay $150 to resolve seven different whistleblower lawsuits alleging that Amedisys billed Medicare for ineligible patients and services. The whistleblowers in those seven cases were collectively awarded $26 million dollars out of that settlement. See DOJ
• In 2015, three related entities in Florida—Recovery Home Care Inc., Recovery Home Care Services, Inc., and National Home Care Holdings LLC—agreed to pay $1.1 million to resolve a whistbleblower lawsuit alleging that the companies paid unlawful kickbacks to doctors in exchange for patient referrals.  The whistleblower in that case received $198,000 of the government’s settlement. See DOJ
• In 2015, Lexington, Kentucky based Nurses’ Registry and Home Health Corporation and the estate of its deceased owner agreed to a $16 million settlement to resolve allegations in a whistleblower lawsuit that the company had paid kickbacks to doctors and engaged in systematic false billing schemes against the United States. See DOJ

To learn more about our Whistleblower & Qui Tam practice, click here. Our firm is located in Nashville, Tennessee but we represent whistleblowers all around the country.