In what's been called the largest home healthcare settlement in the history of the False Claims Act, Amedisys, Inc. and its affiliates agreed to pay $150 million to the federal government to settle allegations of filing false Medicare claims, the U.S. Department of Justice announced last week. The settlement resolves seven lawsuits alleging the company improperly billed Medicare between 2008 and 2010 for services that were medically unnecessary, provided to patients who weren't homebound, or provided to clients who didn't need skilled care and therapy, Bloomberg reported.
"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 Department of Justice stated.
Prosecutors also alleged Amedisys employees coordinated patient care at below-market rates for a Georgia-based oncology practice that referred patients to the company, according to the Associated Press. Since hospice providers depend on referrals, payers should watch for improper financial relationships and marketing activities involving providers and outside businesses, as FierceHealthPayer: Anti-Fraud reported.
The Amedisys settlement is "a relatively massive amount considering the size of the company and its current financial condition," according to a report Bloomberg referenced; the settlement does not constitute admission of wrongdoing.
Operating in 37 states, the District of Columbia and Puerto Rico, Louisiana-based Amedisys is one of the nation's largest home health and hospice providers. The corporation services more than 380,000 patients annually and works with more than 2,200 hospitals and 61,000 physicians, Bloomberg noted.
Whistleblowers in this case will share more than $26 million. The first to come forward was fomer Amedisys employee April Brown, a single mother of two, who found herself scheduled on nursing shifts with the highest degree of difficulty after reporting alleged wrongdoing, according to an announcement from law firm Frohsin & Barger. Brown subsequently lost her job and almost lost her home; now she's slated to collect more than $15 million.