On Monday, the Justice Department revealed that three home care agencies that operate in Texas, Ohio, and Indiana have agreed to pay almost $4.5 million to settle claims that they offered unlawful kickbacks in exchange for Medicare referrals.
Between 2013 and 2022, Guardian Health Care, Gem City Home Care, and Care Connection of Cincinnati – all owned by Evolution Health – reportedly paid out a sum of $4,496,330. The companies are alleged to have provided lease payments and other perks, including wellness health services, event tickets, and meals, to different assisted living communities and their residents. In return, these communities would refer Medicare beneficiaries to the home health providers, who would then bill Medicare for the services provided to the referred patients.
The DOJ states that indulging in such activities goes against the Anti-Kickback Statute. This law prohibits companies from offering any kind of payment or reward with the intention of encouraging referrals to government healthcare programs.
In a statement, Brian Boynton, the head of the DOJ’s civil division and principal deputy assistant attorney general, emphasized the need to prevent any involvement of inappropriate financial incentives in patient care decisions.
Regulators have been uncovering serious violations, leading to increased scrutiny of false claims. The False Claims Act has been violated resulting in almost $2 billion in improper payments authorized by the Centers for Medicare & Medicaid Services in 2022. This has made legal action against non-compliant providers more common.
legal experts have identified several activities that can often result in false claims litigation. These include engaging in kickbacks, upcoding, partnering with providers who have been barred from Medicare or Medicaid programs, insufficient face-to-face visits with patients, and inadequate documentation of a client’s medical necessity for services.
Last week, CMS proposed a rule to combat false claims regarding urinary catheters. The move was made in response to evidence presented by the National Association of ACOs earlier this year, which suggested that false claims for catheters could have cost Medicare over $3 billion. The proposed rule aims to mitigate the impact of significant, anomalous, and highly suspect billing activity related to catheters and improve CMS’ ability to monitor billing in this area.
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