Post-acute care providers in Florida are feeling the heat of fraud and false claims enforcement and paying the price in the form of multi-million dollar settlements.
The largest of the bunch involves Hebrew Homes Health Network Inc., a skilled nursing facility (SNF) with locations throughout Miami-Dade County, which paid $17 million to settle claims that it provided kickbacks to physicians in exchange for Medicare referrals, according to a Department of Justice (DOJ) announcement. It was the largest settlement involving alleged Anti-Kickback violations by a SNF, although other SNF providers have settled false claims allegations for more. In October, Extendicare settled substandard care allegations for $38 million, and in April, HCR ManorCare was hit with a lawsuit alleging the company boosted payments by keeping patients longer than necessary.
Federal prosecutors alleged that Hebrew Homes hired physicians under the title of medical director that included a contract of stipulated duties. However, these were "ghost" positions, created as a way to pay the doctors for patient referrals while making those payments appear legitimate. As part of the settlement, the executive director of the Hebrew Homes agreed to resign, and the company entered into a corporate integrity agreement.
Days later, Covenant Hospice Inc., a hospice provider with locations in Southern Alabama and the Florida Panhandle, paid $10.1 million to settle claims that it overbilled Medicare, Tricare and Medicaid for hospice services, according to a DOJ annoucement. For two years, Covenant allegedly billed the three federal insurers for general inpatient care, the highest rate of hospice reimbursement, when it should have billed for routine home care, which offers the lowest reimbursement rate. The claims submitted did not have appropriate medical records to support the higher billing rate, according to the release. In December, FierceHealthPayer: Antifraud reported that hospice fraud was catching the eye of federal investigators across the country.
Finally, a Jacksonville home health provider paid $1.7 million to settle claims that it billed Medicare for unnecessary services, according to an annoucement by the U.S. Attorney's Office for the Middle District of Florida. Advanced Homecare Inc. allegedly created a set of "neurocare protocols" in order to get home health referrals from two neurologists. Prosecutors also alleged that Advanced Homecare "aggressively" marketed home health services and used physician signature stamps to approve orders.
The home health industry has routinely faced legal pushback throughout the last several years, with schemes ranging from $56 million to $75 million. In states, like Ohio, home health fraud has become such a large concern within the state that legislators have begun to look at ways to better regulate the industry.
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HCR ManorCare hit with False Claims Act complaint
Hospice fraud cases catching eye of federal investigators
Home health programs have the best intentions but are often plagued with fraud