False and fraudulent claims and billing were the theme in key enforcement actions relating to the health care industry announced last week by the U.S. Department of Justice (DOJ). Here’s a summary of four of the main cases:
April 29: Home health company SHC Home Health Services of Florida, LLC, and its related entities paid $2.1 million to the federal government to settle false claims allegations. According to the DOJ, the company allegedly submitted fraudulent or false claims to Medicare for providing home health services to Medicare beneficiaries who did not meet the appropriate requirements to receive that care.1
May 5: Another home health care company, Integrity Home Care Solutions, LLC, which is based in Massachusetts, paid $550,000 to resolve allegations of false billing. According to the Massachusetts Office of Attorney General Maura Healey, the company and its owners allegedly did not get the appropriate authorization from a physician showing that services it billed to the state’s Medicaid program were medically necessary.2
May 9: A Southern California Center providing services to autistic children paid $650,000 to settle fraudulent billing allegations. The center, Prism Behavioral Solutions, which provides Applied Behavioral Analysis therapy to children with autism and related disorders, allegedly billed California’s Medicaid Program for services to autistic children that it never actually provided.3
May 9: Three people were found guilty of participating in an $18.5 million fraudulent billing scheme that involved submitting fraudulent claims to California’s Drug Medi-Cal program for drug and alcohol treatment for middle and high school students. So far, 19 people have been convicted of federal criminal charges relating to the case, which involved the non-profit substance abuse treatment services company Atlantic Recovery Services (ARS), which was later renamed to Atlantic Health Services. Those involved in the scheme billed Drug Medi-Cal for services provided to students who didn’t actually need drug or alcohol treatment, according to the DOJ.4
References:
- https://www.justice.gov/usao-wdky/pr/home-health-company-operating-florida-pays-21-million-resolve-false-claims-allegations
- https://www.mass.gov/news/ag-healey-secures-550000-from-home-health-care-company-to-resolve-false-billing-allegations
- https://www.justice.gov/usao-sdca/pr/southern-california-center-autistic-children-pays-650000-resolve-allegations-fraudulent
- https://www.justice.gov/usao-cdca/pr/3-found-guilty-participating-scheme-submit-millions-dollars-fraudulent-bills-substance