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DOJ Announces Amedisys to Pay $150 Million in Healthcare Fraud Cases

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Recently, the Department of Justice announced that the home health company Amedisys will be paying $150 to the federal government as a means to settle their False Claims Act allegations regarding suspected healthcare fraud. The allegations state that the company turned in false billings to Medicare. Amedisys, based in Louisiana, is one of the largest home health service providers in the country. They have services in Washington D.C., Puerto Rico, and thirty-seven states, giving them a large and prominent presence in the field.

The Settlement to Resolve Whistleblower Allegations

A whistleblower alleges that between 2008 and 2010, the company was billing Medicare improperly and doing so with full knowledge and intent. They claim that they were billing for services and patients that were ineligible. The lawsuit claims that the company billed for an array of therapy and nursing services that were unneeded, and that they were providing care for patients who were not homebound. The allegations go on to say Amedisys was also misrepresenting other medical conditions regarding their patients as a means to increase the amount of money they were making from Medicare.

The actions are in direct violation of the law, and under the False Claims Act, it states that it is” unlawful for a company or individual to submit a false claim for payment from a government program, such as Medicare”. The only time Medicare will reimburse companies and providers for treatments is when those medical treatments and therapy really are truly necessary from a medical standpoint. The allegations show that Amedisys was reworking data as a means to make patients appear to have more dire medical treatments than they really needed. Doing this would allow the companies to justify the need for additional therapy, thus charging Medicare more money.

At first, it might appear as though the company was doing this in order to provide more care for their patients who might not otherwise receive it. That was not the case though. The management allegedly told the nurses and the therapists to make the data appear as though the patients needed more therapy or treatment when they really did not need more help. They had the caregivers focus on improving the profits for the company, which had little to do with the actual health of and care for the patient.

What Else Will the Settlement Solve?

In addition to the fraud charges, the settlement will also solve some other issues and allegations brought against Amedisys. The allegations state that Amedisys also was in violation of Anti Kickback and Stark Laws, claiming that they had “improper financial relationships with referring physicians”. The law restricts having financial relationships between these companies and the physicians that are providing care and referring patients.

In all, the settlement will take care of seven lawsuits against Amedisys filed by whistleblowers. The False Claims Act features qui tam provisions for people to bring lawsuits on behalf of the government against companies that may be committing illegal acts. The whistleblowers are able to share in some of the monetary damages received during the suit. The amount that the whistleblower can receive will vary, but it generally tends to range between 15% and 30%. In the case against Amedisys, the whistleblowers involved will split $26 million.

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