CareAll Management LLC, one of Tennessee's largest home healthcare providers, agreed to pay $25 million plus interest to resolve allegations of filing false and upcoded Medicare and Medicaid claims, the U.S. Department of Justice announced.
The company was accused of exaggerating the severity of beneficiaries' medical conditions, billing for services that were not medically necessary and claiming payment on behalf of people who weren't homebound, the announcement noted. These billings occurred between 2006 and 2013.
The whistleblower in this case, Toney Gonzales, will collect more than $3.9 million, the DOJ reported. However, CareAll officials said a company-sponsored, independent audit identified home visit documentation problems that CareAll disclosed to the government, The Tennessean reported.
"Fraudulent home-based services are surging across the country," said Office of Inspector General Special Agent in Charge Derrick L. Jackson in the announcement. "We will continue to protect both Medicare and taxpayers, and ensure that funds are not siphoned off by companies more concerned with the bottom line than patient care."
At least four other Nashville healthcare companies have faced similar federal scrutiny as of late, The Tennessean noted. And recent prosecutions have highlighted program integrity weaknesses in both consumer-directed and agency models of home care, as FierceHealthPayer: AntiFraud reported.
This wasn't CareAll's first brush with the law. Seven companies in CareAll's healthcare group collectively paid the United States about $9.38 million in 2012 after allegedly filing false cost reports with Medicare. CareAll companies reportedly hid their relationship to the entity managing them on billings submitted between 1999 and 2001, according to the Washington Examiner. This allegedly boosted the company's Medicare reimbursements.
As part of the CareAll's recent false claims settlement, the provider entered into "an enhanced and extended" corporate integrity agreement in an effort to prevent future regulatory compliance lapses and fraud, the announcement noted. The agreement runs through 2019.