Tennessee home healthcare company CareAll will pay the government $25 million to settle allegations that it exaggerated patients’ sicknesses and billed for medically unnecessary services to get more money from Medicare and Medicaid, the U.S. Justice Department announced Wednesday.
The case, originally brought by a whistle-blower under the False Claims Act, alleged the company between 2006 and 2013 overstated the severity of patients’ conditions and billed Medicare and Medicaid for medically unnecessary services for patients who were not homebound.
CareAll has been cooperating with the government for months to resolve the issues, the company said in a statement Wednesday.
“Through an independent audit paid for by CareAll, we identified home health visits that were not properly documented and provided that information to the federal government,” CareAll said in the statement. “CareAll has always provided the highest level of care to its patients, but because of paperwork technicalities, the funds received for making certain home visits must be repaid.”
The case is part of a “surge across the country in fraudulent home-based services,” noted Derrick L. Jackson, special agent in charge at HHS’ Office of the Inspector General, in a Justice Department release.
The whistle-blower in the case, Toney Gonzales, alleged, among other things, that he was demoted from director of services for CareAll’s Knoxville office to a registered nurse position in 2012 partly because he refused to participate in the fraud, according to the original complaint. Under the False Claims Act, whistle-blowers are entitled to a percentage of the dollars the government is able to recover. Gonzales will receive $3.9 million.
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