Wednesday, November 1, 2017

Recent Settlements of False Claims Act Cases

Lilly Hummel

The Department of Justice (DOJ) announced that Catholic Health has agreed to a settlement of $6 million to resolve a qui tam (i.e., whistleblower) lawsuit that its subsidiary, Home and Community Based Care, violated the False Claims Act by submitting false claims to government health care programs. The Western District of New York brought the case, which alleged that services provided at long and short-term skilled nursing care and post-acute care facilities were unreasonable, not medically necessary and unsupported by the medical records. The false claims were related to Ultra High Resource Utilization Group (RUG) levels. As part of the settlement, Catholic Health has agreed to enter into a five-year Corporate Integrity Agreement with the Office of Inspector General (OIG).

Health Services Management Inc. (HSM) has paid $5 million to resolve claims that the company billed the Medicare and Medicaid programs for worthless services and for services that were never provided. The lawsuit, originally brought by a whistleblower, was filed for poor quality of care against Huntsville Health Care Center, a 92-bed nursing home and rehabilitation facility that HSM owned and operated in Texas. As part of the settlement, HSM agreed to enter into a Corporate Integrity Agreement with OIG.

DOJ and OIG have recently settled several other cases that involve post-acute and long-term care providers. For example, the largest for-profit hospice chain has agreed to pay $75 million to resolve a government lawsuit alleging violations of the False Claims Act between 2002 and 2013. The government’s complaint alleged that Vitas, which is now owned by Chemed Corporation, billed for patients who were not terminally ill and thus did not qualify for the Medicare hospice benefit, and submitted false claims for continuous home care services that were not necessary, not actually provided, or not performed in accordance with Medicare requirements. Vitas also entered into a five-year Corporate Integrity Agreement with OIG.

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