Home Health & Hospice Week

Feds pursue PT fraud in Michigan.

If you’re tempted to sweep your billing transgressions under the rug and move forward with a clean slate — don’t. That’s a lesson a Georgia company has learned the hard way.

Norcross-based PruittHealth Inc. and affiliated entities have agreed to pay $4.2 million to resolve fraud allegations. For 18 months starting in January 2011, Pruitt “knowingly submitted claims to Medicare and Medicaid for home health services that were not eligible for reimbursement because ... they did not have the required face-to-face certifications or plans of care, and they did not document the beneficiary’s homebound status or need for the home health services,” the Department of Justice says in a release.

But the company that also operates skilled nursing and senior living facilities compounded that problem, the DOJ contends. “Pruitt learned that it had received payments for home health services to which it was not entitled, but failed to disclose its receipt of the overpayments, or refund the overpayments to Medicare and Medicaid in a timely manner,” the release alleges.

Pruitt did take steps to rectify its billing problems after discovering them, including hiring an outside consultant and implementing internal audits, the DOJ allows. But “although the Government has taken these steps into consideration, this is not an indication or concession as to the sufficiency of these compliance measures,” Justice says.

The case was initiated by whistleblower Tina Peery, who will receive more than $700,000 from the settlement, the DOJ notes. Peery worked for the company in 2012 and 2013 as a regional administrator in its home health business in Atlanta, reports the Atlanta Journal Constitution newspaper. Her 2014 qui tam suit, unsealed last month, says she was fired after complaining that the company needed to repay the money.

Changing Dates On Certs Leads To Treble Damages

Meanwhile, in Michigan a home health agency, related physical therapy practice and their owner have agreed to pay $450,000 to settle Medicare fraud charges.

Traverse City-based Great Lakes Home Healthcare Specialists, Great Lakes Therapy Housecalls, and their owner, James A. Harvey, altered the dates of physician signatures on home health certifications; knowingly hired an unqualified person as a medical social worker and billed Medicare for episodes that included that MSW’s services; falsely submitted claims for PT services under the name of an employee while she was on maternity leave; and knowingly billed Medicare for additional units of physical and occupational therapy services that were never provided, the DOJ says in a release.

“Lying to the government when seeking Medicare reimbursement and falsifying patient records cheats taxpayers everywhere who support the Medicare Program,” says U.S. Attorney Andrew Birge in the release. “My office will come after false billing like that not only for the civil penalties but also for the treble damages as well to deter future cheating.”