Home Health & Hospice Week

Agencies pay millions to settle improper billing charges.

Don’t write off complaints to the OIG and even whistleblower lawsuits as just sour grapes from disgruntled employees that will soon fade away. One Florida home health agency is paying millions to settle charges raised through those avenues.

SHC Home Health Services of Florida and its related entities known collectively as Signature HomeNow have paid $2.1 million to the U.S. government “to settle claims of improperly billing the Medicare Program for home health services provided to beneficiaries living in Florida,” the Department of Justice says in a release. Signature HomeNow’s corporate headquarters is in Louisville, Kentucky.

From 2013 to 2017, Signature HomeNow billed for home health patients that weren’t homebound, didn’t require skilled care, didn’t have a valid plan of care in place, and didn’t have necessary face-to-face physician encounters, the DOJ alleges. “This matter arose from a complaint to the Department of Health and Human Services, Office of Inspector General (HHS OIG) complaint hotline (https://oig.hhs.gov/fraud/report-fraud/) and from a complaint for monetary damages under the qui tam provisions of the federal False Claims Act,” according to the release.

“This office will continue to vigorously pursue unscrupulous health care providers who attempt to defraud the Medicare program,” says Michael A. Bennett, U.S. Attorney for the Western District of Kentucky, in the release.

“When health care companies try to boost their profits by fraudulently billing federal health care programs, our agency will work closely with our law enforcement partners to hold them accountable for their schemes,” HHS OIG Atlanta Regional Office Special Agent in Charge Tamala Miles says in the release.

State Continues HH Fraud Hunt

In another case further North, a Tewksbury, Mass.-based HHA and its owners will pay $550,000 to resolve allegations that they billed the state’s Medicaid program, MassHealth, for services that had not been appropriately authorized by a physician, Attorney General Maura Healey says in a release. Integrity Home Care Solutions, President and CEO Joseph W. Kimani, and Vice President Beatrix Fingfing “failed to comply with MassHealth regulations that require a provider to obtain physician authori­zation confirming the services are medically necessary before submitting claims to MassHealth,” Healey says.

In addition to repaying the money, “Integrity and its owners agreed to … implement a three-year compliance program, overseen by an independent compliance monitor, that will require Integrity to establish updated policies, procedures, and trainings to ensure compliance with MassHealth regulations and will conduct annual on-site audits,” the AG’s Office notes.

“Today’s settlement is part of a larger effort by AG Healey and MassHealth to combat fraud in the home health industry,” the release notes. “Since 2016, the AG’s Office has successfully prosecuted three home health agencies and their owners and settled civilly with 13 home health agencies, returning approximately $50 million to MassHealth.”

The more than half-million dollar case pales in comparison to Healey’s last settlement with an HHA, which was for $6.53 million with Compassionate Homecare Inc. in March (see HCW by AAPC, Vol. XXXI, No. 13).