EHRs assist home health provider in $21.5 million overbilling scheme

Fraud

A home health provider with offices in seven different states admitted to knowingly submitting false claims for homebound patients with the help of its electronic health record (EHR) system that allowed practitioners to easily replicate notes from other records, according to the Department of Justice.

Headquartered in Louisville, Kentucky, MD2U has clinics in states throughout the Southeast and Midwest. According to the government’s complaint, between 2007 and 2014 non-physician providers (NPPs) with MD2U consistently billed Medicare for the highest level of care that required at least 60 minutes of evaluation even though most visits lasted less than 10 minutes. A review of selected patient files revealed that 98 percent of MD2U’s claims were false either because the visits were not medically necessary or because they were upcoded to the highest level. In fact, many of the patients worked, attended school, and even went horseback riding.

NPPs thoughout the organization were trained to bill home visits at the highest level and schedule unnecessary follow-up visits. In order to create documentation that made it appear practitioners were providing the care required to bill high-level care, NPPs cut, copied and pasted notes from the company’s EHR system, sometimes weeks, months or even years in advance. In other instances, providers were instructed to go back and change patient documentation in order to comply with billing requirements.

MD2U and the company’s senior executives admitted to all charges and agreed to pay $21.5 million over the next five years, as well as enter into a corporate integrity agreement.

In April, the Office of Inspector General (OIG) reiterated concerns that the Department of Health and Human Services (HHS) was not doing enough to limit the use of copy-paste functions in EMRs that could lead to fraudulent claims.  

The OIG has also recognized the home health industry as a hot spot for fraud, recently identifying billing outliers associated with more than 500 providers and raising concerns about physician compensation agreements. Despite pushback from providers and legislators, CMS recently announced it would move forward with a pre-claim review pilot project for home health providers in five states.  

To learn more:
- here’s the DOJ statement
- read the government’s complaint (.pdf)

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