KNOXVILLE, TN _ Affiliated home health entities Home Health Care of East Tennessee, Inc.; Home Health Care of West Tennessee, Inc.; Home Health Care Services, Inc.; Home Health Care Services II, Inc.; Health Care Staffing of Tennessee, Inc.; and Home Health Care Support Services, Inc. (collectively “Home Health”) have agreed to pay the United States $1,800,000, to settle False Claims Act liability. Each of the Home Health entities is based in Chattanooga, Tennessee.
The United States contends that Home Health billed Medicare for home health services and, in some cases, hospice services that were not properly payable due to compensation or other financial arrangements with certain referring physicians which either violated or failed to meet the requirements of the Ethics in Patient Referrals Act (also known as the “Stark law”). The United States also contends that certain other billed services were not properly payable because they failed to meet Medicare coverage and payment requirements due to false or invalid certifications. The conduct giving rise to the allegations occurred over a period of time ranging from as early as 2002 to 2013.
Medicare home health providers and hospice providers are required to obtain written physician certifications of eligibility for each home health or hospice beneficiary upon the start of care and periodically throughout the beneficiary’s period of care. Medicare requires these certifications prior to billing in order to help ensure that home health or hospice care is medically necessary. Moreover, home health and hospice providers are required to comply with the Ethics in Patient Referrals Act, which requires that compensation and other financial arrangements with referring physicians meet requirements designed to ensure that physicians make patient referral decisions based on the patients’ best interests, without undue influence from payments or financial benefits received from healthcare providers competing for the physicians’ referrals. The law also serves to protect the integrity of government-funded healthcare programs.
In November 2010, Home Health initiated a voluntary disclosure to the U.S. Attorney’s Office, disclosing that it had uncovered potential violations of the Stark law during the course of an ongoing internal audit. Home Health supplemented its voluntary disclosure from time to time as its internal investigation continued, reporting additional violations. The settlement announced today resulted from the companies’ voluntary disclosures.
“This is an excellent example of how a health care provider can self-report Medicare compliance concerns and avoid costly litigation,” said Nancy Stallard Harr, U.S. Attorney for the Eastern District of Tennessee. “We encourage voluntary disclosures and welcome the opportunity to work with providers to resolve issues such as this and protect the Medicare Trust Fund.”
