One area of False Claims Act cases that, regrettably, appears to be a growth industry is the area of home health care fraud against Medicare and Medicaid. In June, 2016, charges against 301 individuals for roughly $900 million in fraudulent billings for home health care fraud were announced by the U.S. Justice Department. The 301 providers include 61 doctors and nurses, as well as other medical professionals. It was the largest such takedown in history, both for the number of people charged and for the amount of money lost through fraud. Many of the cases prosecuted by the Justice Department involved false billings to Medicaid, Medicare, or both, for nonexistent treatments.
The nationwide sweep through 36 federal districts, headed by the Medicare Fraud Strike Force, also involved 23 state Medicaid Fraud Control Units.
The charges are wide-ranging, including conspiracy to commit health care fraud, violating the anti-kickback statutes, aggravated identity theft, and money laundering. The fraud schemes involved the areas of home health care, physical therapy, occupational therapy, psychotherapy, durable medical equipment, and prescription drugs. In fact, more than 60 of the 301 defendants were charged with Part D fraud, which is Medicare’s prescription drug program. In many cases, false claims were submitted for treatments that were not only medically unnecessary, they were often not even provided.
In another home health care case, the government resolved fraud charges against the Louisville, KY, company MD2U, a primary-care service that visits patients in their homes. MD2U admitted that they committed fraud and have settled a federal false claims suit by agreeing to pay back millions of dollars.
The government alleged that, from July 2007 through November 2014, MD2U did the following:
- Sent in false billings for cases where patients were neither homebound nor confined to their homes
- Billed the government for home medical visits that were unnecessary
- Upcoded billings (billed Medicare and Medicaid using codes that gained a higher reimbursement when a lower-paying code was more accurate)
- Cloned medical records (copied and pasted information rather than entering fresh, accurate information) as a justification for patient visits.
The federal special agent in charge, Derrick Jackson with the Office of Inspector General (OIG) in Atlanta, commented in a press release,
“This provider billed for medically unnecessary home visits and often grossly exaggerated the level of service provided. The OIG is committed to protecting the integrity of federal health care programs by aggressively pursuing entities that increase their revenue through deceitful schemes and trickery.”
Since January 2009, a total of over $18.3 billion has been recovered by the U.S. Justice Department and U.S. Attorney’s Offices across the country for fraud against federal health care programs. Nearly $1 billion of that amount comes from the two settlements named above.
The Whistleblower Lawyer
If you think you have the facts needed to bring a whistleblower case, the experienced whistleblower attorneys at the Louthian Law Firm can review your case and help you file the appropriate disclosure statement. Under some circumstances, the government will intervene, or join in your lawsuit.
Your chances of succeeding are greater if your whistleblower claim is substantive, clear, and to the point. Because of this, meeting with a qualified whistleblower attorney can increase your chances of winning. The Louthian Law Firm can help you form your claim so that the government will be more inclined to intervene in your case; government intervention can sometimes increase the chances of recovering reward money. Even if the government decides not to intervene, it could still be a good idea to pursue your case without government involvement. Our strong support system can assist you through every step of the process.
For a free, confidential evaluation of your case, call the Louthian Law Firm today at 1-803-454-1200 or, if you prefer, you can fill out our online contact form.