Home Care Providers Face $4.5M Settlement for False Claims Allegations

WFCN —

According to the Justice Department, three home care companies with locations in Texas, Ohio, and Indiana have agreed to pay about $4.5 million to settle claims that they gave unlawful kickbacks in exchange for Medicare referrals. The announcement was made on Monday.

The Evolution Health-owned organizations Guardian Health Care, Gem City Home Care, and Care Connection of Cincinnati collectively paid $4,496,330. In exchange for referring Medicare beneficiaries, the three corporations are accused of offering lease payments and other amenities, including wellness health treatments, event tickets, and meals, to residents of various assisted living residences between 2013 and 2022. After that, it is said that the home health providers invoiced Medicare for the services they rendered to the patients who were recommended.

Such actions are illegal under the Anti-Kickback Statute, which forbids businesses from paying compensation with the intention of encouraging referrals to government healthcare programs, according to the DOJ.

Chief of the DOJ’s civil division and principal deputy assistant attorney general Brian Boynton stated in a statement, “It is imperative to ensure that improper financial incentives play any role in decisions regarding patient care.”

SEE MORE –

Illegal Fireworks Worth Up to $10 Million Seized by Gardena Police – Check It Here

As authorities continue to find significant infractions, there has been a rise in the inspection of false claims. Nearly $2 billion in erroneous payments that were approved in 2022 in violation of the False Claims Act were estimated by the Centers for Medicare & Medicaid Services. Consequently, it is now increasingly normal to take legal action against providers who ignore orders.

A lack of in-person patient visits, upcoding, contracting with providers disqualified from the Medicare or Medicaid programs, kickbacks, and inadequate documentation of a client’s medical necessity for services are among the practices that often result in false claims litigation, according to legal experts.

In an effort to combat bogus claims, CMS this week proposed a rule that would lessen the effects of large, unusual, and highly suspicious billing activity pertaining to urinary catheters. It was sparked by information that the National Association of ACOs found earlier this year suggesting that Medicare may have paid more than $3 billion in fraudulent claims for catheters.

By addressing these cases of fraud, CMS’s proposed rule would enable it to more effectively oversee catheter billing.