Healthcare Business News

Amedisys to pay $150 million for overbilling Medicare

By Beth Kutscher
Posted: April 23, 2014 - 4:00 pm ET

Amedisys, one of the largest home health and hospice companies in the U.S., has finalized a $150 million settlement to resolve allegations that it improperly billed Medicare for nursing and therapy services.

The Baton Rouge, La.-based company disclosed a tentative agreement with the government last year. In February, Amedisys removed longtime CEO Bill Borne as it struggled with declining volume and reimbursement as well as pressure from its largest shareholder.

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The pending settlement was a lingering cloud for the company, which amended its credit facility to finance the sum. Under the agreement, Amedisys also will enter into a corporate integrity agreement with HHS' inspector general's office.

The U.S. Justice Department investigated a variety of allegations against the company raised by whistle-blowers in seven False Claims Act lawsuits. According to the agreement, the government concluded Amedisys billed Medicare for ineligible patients and services and misrepresented patients' conditions to justify higher reimbursement.

One of the complaints alleged that Amedisys violated the anti-kickback statute by referring patients to a Georgia oncology practice that provided care-coordination services at below-market rates in exchange.

Amedisys said it disputes the allegations but decided to settle to avoid the uncertainty and expense of protracted litigation.

"We are pleased to put this matter behind us," said Ronald LaBorde, president and interim CEO, in a news release. "We are intensely focused on achieving the best possible outcomes for our patients by providing the care they need, when they need it, in the comfort of their own homes. We strive diligently to ensure that our operations are fully compliant with Medicare program requirements."

Amedisys must pay $115 million plus interest by May 2, and the remaining $35 million plus interest by Oct. 23.

As part of the agreement, the whistle-blowers will split more than $26 million.

Follow Beth Kutscher on Twitter: @MHbkutscher

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