Bankrupt home-healthcare provider HealthEssentials Solutions has pleaded guilty to a felony charge of making false statements to the CMS in a multiyear practice of upcoding visits in the face of repeated signals to company officers that they were breaking Medicare rules.
A plea agreement filed March 28 in U.S. District Court in Louisville, Ky., where the company was based, calls for restitution of $3.1 million pending approval from the U.S. Bankruptcy Court, also in Louisville. In October 2004, as HealthEssentials Solutions was headed toward a high-flying initial public offering of stock, HHS investigators and FBI agents raided its corporate headquarters. A few months later the company filed for bankruptcy protection.
The company admits that it inappropriately used codes intended for home visits when its nurse practitioners were in fact providing management and evaluation services at nursing homes and assisted-living facilities. According to the facts laid out in the plea deal, officers sought opinions from outside experts regarding its coding in 2000 and 2001 but kept the results from outside directors on its board. Explicit guidance received from the CMS on the matter was likewise ignored.
Michael Barr, the company's president and chief executive officer, indicated in a December motion in bankruptcy court that he "has been identified as a person of interest in an ongoing criminal investigation." -- by Gregg Blesch