Friendship Home Healthcare: An Excluded Nurse and Forged Nursing Records

In the Friendship Home Healthcare settlement, the company group and its owner paid $6.5 million to resolve allegations involving excluded nursing staff, forged nursing records and retained TennCare overpayments. A licensed practical nurse who had worked for Friendship brought the case.

The Justice Department’s June 1, 2015 announcement described allegations involving TennCare, Medicare and TRICARE from July 2007 through July 2013. The detailed staffing, signature and repayment allegations concerned TennCare.

What Friendship Home Healthcare Allegedly Billed For

The government alleged that Friendship billed TennCare for private-duty nursing furnished or supervised by an excluded worker, submitted forms with a forged Director of Nursing signature, and billed without required forms and signatures. It separately alleged that Friendship kept payments after learning that a nurse’s license had lapsed.

The Nashville-based business operated under several names. The detailed staffing, signature and repayment allegations concerned its TennCare billing.

When a Home Health Agency Uses Excluded Nurse Services

When a home health agency uses excluded nurse services, the worker’s role matters even if the agency submits the bill. In Friendship’s case, the government alleged that the excluded woman either furnished or supervised the private-duty nursing billed to TennCare.

Private-duty nursing involves registered or licensed practical nurses providing more individual and continuous attention than ordinary visiting nursing, under physician direction. The staffing question therefore reaches into who delivered and supervised that care. A billing department can see the agency name while a scheduler or clinical employee knows who actually covered the work.

The federal exclusion framework reaches services furnished by excluded workers through an agency’s billing number. That is why worker identity belongs alongside the service and claim, rather than disappearing behind the company’s enrollment. The broader question of staff qualifications in home health billing has the same practical starting point: who did the work that the claim represents?

Forged Nursing Records Turned Approval Into an Allegation

The forged nursing records allegation concerned the signature of Friendship’s Director of Nursing on required TennCare forms. The government also alleged billing without the required forms and signatures. One allegation concerns an approval presented as authentic; the other concerns claims submitted without the required approval documents.

Someone who knows the Director of Nursing’s work may know whether the apparent approval matches what happened. We look at that connection to the paid claim, including who supplied the document and how it was used.

The original document, the purported signer and the claim each tell a different part of the story. A clinical employee may know that an approval was invented while a billing employee knows which services it supported. Connecting those views is the work a whistleblower case needs.

The Overpayment Allegation Began With Discovery

The government alleged that Friendship failed to repay TennCare within 60 days after learning it had wrongly billed for care supplied by a woman whose nursing license had lapsed. This part of the case turns on what happened after the agency learned of the problem. An insider in clinical management and an insider in accounts receivable may see different pieces of the same decision.

The pattern appears in other home health cases. The PruittHealth settlement resolved allegations involving deficient encounter, plan-of-care and homebound documentation together with a failure to return identified overpayments. The Accurate Home Care resolution concerned alleged retention of duplicate reimbursements and overpayments. Different billing problems, the same question after discovery: what happened to the money?

What the Friendship Settlement Paid

The paid settlement allocated $4,025,573 to the United States and $2,474,427 to Tennessee. The former employee brought a qui tam case under the False Claims Act, and the United States and Tennessee joined it. The Department of Health and Human Services’ Office of Inspector General, the Tennessee Bureau of Investigation Medicaid Fraud Control Unit and the Defense Criminal Investigative Service investigated the claims against Friendship and its owner.

Friendship and its owner also agreed to a five-year Corporate Integrity Agreement with the health department’s Office of Inspector General. That agreement required an independent organization to review Medicare and Medicaid claims and reimbursements. Those reviews would produce a further dispute about money Friendship had to return.

The Later Reviews Found Overpayments That Stayed Unpaid

In an October 31, 2019 administrative decision, a Department of Health and Human Services judge found that Friendship and its owners had breached the agreement three times by failing to repay overpayments. They owed $1,322,500 in penalties under the agreement. The demand letter cited in the decision identified $1,930,883 in unpaid overpayments. The agreement gave Friendship 30 days to repay what the independent reviewer found.

The review findings were substantial. For the reporting year running from June 2016 through May 2017, the decision records a Medicare claim denial rate of 98% and a Medicaid claim denial rate of 51%. The reviewer notified Friendship of the overpayments, and correspondence confirmed receipt of the findings.

Friendship’s response focused on finding financing or selling the business to fund repayment. Its brief argued:

We see the absurdity: a settlement, an integrity agreement, and still the public money stayed unpaid. An agreement to return it becomes a promise to try to find it. The judge rejected the argument and held that the agreement required repayment.

For an insider, this adds a different set of records to the story: independent reviews, notices of overpayments and management’s responses. The reviews identified the money to be returned, the correspondence showed that Friendship knew, and repayment had not followed when HHS-OIG demanded penalties.

What Evidence Is Needed to Prove Fraud?

For home health care billing like Friendship’s, the useful evidence connects the worker, the nursing record and the paid claim to what the agency knew. The exclusion status, license history, disputed signature and notice of an overpayment answer different questions. We work with the insider to establish how those facts connect.

A scheduler may know who furnished or supervised care. A nursing manager may recognize a signature that was never authorized. A billing or finance employee may know when a payment problem reached management and whether the money went back. The later Friendship decision shows how an independent review and the response to it can make that last connection particularly clear.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. The value of an insider’s account here is specific: it can explain the gap between the nursing work, the record used to bill for it and the decision to keep a payment after the problem became known.

You Know Who Worked and Who Signed

If you know the nurse behind the billed service, the signature that was forged or the overpayment management kept, talk with our whistleblower experts about the agency’s billing. We build your strongest home health whistleblower case with you, bring in home health fraud whistleblower lawyers who understand staffing and repayment cases, and stay beside you as the case moves forward.