Home Health & Hospice Week

Oklahoma-based agency and execs settle fraud charges in 2 different suits for a whopping $30 million.

Employees have over a million more reasons to head to the authorities with their complaints about your agency’s practices, in light of a recent fraud settlement.

Oklahoma-based Carter Healthcare, its affiliates CHC Holdings and Carter-Florida, and their president Stanley Carter and COO Bradley Carter have agreed to pay $7.175 million to resolve allegations that they violated the False Claims Act by billing the Medicare program for medically unnecessary therapy provided to patients in Florida, the Department of Justice says in a release. Bradley Carter will pay $175,000, Stanley Carter will pay $75,000, and Carter Healthcare will pay the remaining $6.925 million, according to the DOJ.

Stanley Carter and Bradley Carter also agreed to be excluded from participation in all federal health care programs for five years and Carter Healthcare agreed to enter a corporate integrity agreement with the HHS Office of Inspector General, the DOJ notes.

Former Carter Healthcare therapists Sharon Mahaffey and Mark Brimer alleged in a whistleblower lawsuit that Carter Healthcare billed Medicare for patients based on therapy provided without regard to medical necessity and overbilled for therapy by upcoding patients’ diagnoses, the DOJ says. Mahaffey and Brimer will share $1.3 million of the settlement.

Plus: Carter Healthcare has agreed to pay nearly $23 million to resolve another qui tam action in Oklahoma, which alleged that the company “improperly paid remuneration to its home health medical directors in Oklahoma and Texas for the purpose of inducing referrals of Medicare and TRICARE home health patients between 2013 and 2020,” according to the release.

“This settlement is a stark reminder to home health providers that our agents are working tirelessly with the Department of Justice to pursue providers that inappropriately bill federal health care programs to boost profits, as alleged here,” HHS OIG Special Agent in Charge Omar Pérez Aybar says of the Florida case. “Our agency will not hesitate to investigate such allegations to protect federal health care programs and the patients served by these programs,” Pérez Aybar pledges.

Other recent fraud cases include:

In Houston: A home health agency owner has been sentenced to 10 years in prison after being convicted of home health fraud back in April. Colony Home Health Services owner Alfred Olotin Alatan paid patient recruiters for referrals, then billed for medically unnecessary services for the patients, the DOJ says in a release (see HHHW by AAPC, Vol. XXXI, No. 16). And a physician at Milten Medical Clinic owned by Francis Ekene, who was also convicted, would sign plans of care for the patients when they weren’t actually under his care. Alatan was also convicted of money laundering. Ekene was also sentenced to 10 years in prison followed by three years of supervised release, the DOJ says.

Also in Houston: A federal jury has convicted a foreign medical student for his part in a home health fraud scheme after a three-day trial. Despite Abudul Audu Azia Ozigi not having a medical license in the U.S., home health agency owner Margaret Arise hired Ozigi to see patients in their homes and certify them for home health, the DOJ says. Ozigi visited patients and qualified them for home health, when they did not need services. Recruiters also were paid to provide patient information to bill for home health services regardless of whether the patients needed care, Justice says. Arise was previously convicted in the case. Ozigi and Arise both await sentencing.