Home Health & Hospice Week

Government finalizes $150 million fraud settlement and releases surprising details.

The $150 million settlement of fraud charges that Amedisys Inc. revealed last fall covers more than just medically unnecessary and upcoded therapy. It also includes charges that the company had “improper financial relationships” with referring physicians, according to the Department of Justice.

The Baton Rouge, La.-based chain disclosed the tentative $150 million settlement amount with its third-quarter earnings figures in November 2013 (see Eli’s HCW, Vol. XXII, No. 40). Now the government has announced that the settlement is final.

The settlement “resolves allegations that, between 2008 and 2010, certain Amedisys offices improperly billed Medicare for ineligible patients and services,” the DOJ says in its new release. “Amedisys allegedly billed Medicare for nursing and therapy services that were medically unnecessary or provided to patients who were not homebound, and otherwise misrepresented patients’ conditions to increase its Medicare payments.”

Clincher: “These billing violations were the alleged result of management pressure on nurses and therapists to provide care based on the financial benefits to Amedisys, rather than the needs of patients,” the DOJ says. The charges were first reported by the Wall Street Journal, which sparked a Senate hearing and the DOJ investigation (see Eli’s HCW, Vol. XIX, No. 19).

“Additionally, this settlement resolves certain allegations that Amedisys maintained improper financial relationships with referring physicians,” the DOJ continues. “The United States alleged that Amedisys’ financial relationship with a private oncology practice in Georgia — whereby Amedisys employees provided patient care coordination services to the oncology practice at below-market prices — violated statutory requirements” in the Stark and Anti-Kickback Statutes.

Whistleblower Lauded In Newspaper For Settlement

April Brown, an Amedisys nurse in Mon-roeville, Ala., filed a federal lawsuit in Birmingham against Amedisys in 2010. Lawsuits from Brown and six other qui tam relators were unsealed with the government’s announcement. Brown’s lawsuit claimed the company violated the False Claims Act by submitting false claims to Medicare, said her attorney, Jim Barger of Frohsin & Barger in Bir-mingham, according to the Birmingham News.

Brown said Amedisys was asking her to bill for services she was not actually providing or that were not necessary. The way Amedisys’ electronic forms were set up, patients were always coded for the highest level of service and the forms did not represent the patients’ true condition, the suit alleged. Brown also had patients who were not really home-bound, he said.

Brown, who was fired after questioning the practice, was the first to file a whistleblower lawsuit, the News notes. The seven total suits were consolidated in a federal court in Pennsylvania, where six of them were filed.

The whistleblowers who filed lawsuits — primarily former Amedisys employees — will collectively split over $26 million, the DOJ says. Brown will get $15 million of that, Barger told the News.

After being fired, Brown worked part-time shifts at a local hospital and cleaned condos on the beach to eke out a living, Barger said. At one point the single mother faced foreclosure on her home. Brown “did what she did with no consequences to herself ... She deserves it (the money). The country needs more people like her,” Barger said.

“Amedisys‑maintains that it operated according to stringent policies requiring that home health nursing and therapy services be delivered to qualifying patients having a medical need for such care, and only upon the direction of their physicians,” the company says in a statement. “The final Settlement Agreement reflects Amedisys’‑disagreement with the DOJ’s claims and includes no admission or determination of wrongdoing,” the publicly reported chain adds.

“We are pleased to put this matter behind us,” says Interim CEO‑Ronald A. LaBorde in the release.