Advanced Homecare: Selling the Care, Stamping the Orders

The Advanced Homecare neurological fraud settlement committed the company to pay $1,293,169 to resolve allegations that it billed Medicare for millions of dollars of unnecessary home health care. The government alleged that marketing employees gained access to a neurology practice’s patient files, completed referral forms and used the doctors’ signature stamps to sign orders. For an insider who saw how referrals became approved care, that is the heart of this case: who actually supplied the judgment behind the signature? Advanced Homecare, Inc. was the Jacksonville, Florida home health company named in the Justice Department’s June 16, 2015 announcement.

Advanced Homecare’s Neurology Referral Protocols

From April 2009 through April 2012, Advanced Homecare allegedly used neurocare protocols to accept and treat patients who were not homebound and lacked valid physician certification of their home health need. The agency accepted referrals from two neurologists. The government alleged that the company recklessly allowed its employees to market aggressively to that practice and circumvent the physician certification requirement.

According to the Justice Department, marketing employees gained direct access to the practice’s patient files. They completed the referral forms. They used the physicians’ signature stamps to sign orders. The agency’s sales activity allegedly extended into the very documents Medicare relied on to establish whether a patient qualified for the services being sold.

We see marketers allegedly controlling both the sales pitch and the doctors’ signatures on the orders. A stamp could supply the signature. The patient’s condition still had to supply the reason for care.

The alleged false claims involved medically unnecessary services billed to Medicare. That connects the office workflow to the money: the government said Advanced Homecare accepted and treated ineligible patients, then billed the public program for that healthcare. Taxpayers were the customers who never sat in on the sales pitch.

Why a Neurology Referral Did Not Establish Home Health Eligibility

Medicare eligibility depends on the patient’s homebound status, skilled-care need and supporting clinical record. Advanced Homecare’s alleged neurocare protocols bypassed those individual judgments: the government described patients who were not actually homebound and orders stamped by marketing employees to get around physician certification.

The Medicare Benefit Policy Manual’s homebound criteria concern how illness or injury affects leaving home, including the person’s need for assistance and the considerable effort leaving requires. For a neurological patient, the clinical question also includes what skilled service the person needs at home. A program label such as neurocare cannot answer that question for everyone referred through the practice.

For a nurse or practice employee, the useful comparison is between the patient’s condition, the physician’s clinical judgment and the agency’s account of why home health was needed. We look at how those accounts came together, and who made them agree.

What Evidence Is Needed to Prove Fraud?

For an allegation involving unnecessary neurological home health services, the evidence connects patient eligibility and physician approval to the care the agency billed. We examine how the clinical facts traveled from the neurology office into the agency’s assessment, plan, visit documentation and Medicare claims.

The practice’s original records matter because they show the medical account that existed before an agency referral was completed. The referral and certification records show what the agency then relied on. Where the concern involves a signature stamp, we want to understand who used it, what order it signed and what physician review supported that order. An employee’s knowledge of the office routine can explain a signature that looks unremarkable on the finished page.

Changes to OASIS assessments can also affect payment. We compare the original clinical assessment with the version used in billing as part of understanding whose account reached the claim.

A practice employee may have seen how a referral was prepared. A visiting nurse may know what the patient actually needed. Someone handling claims may know which version reached billing. Our work with an insider is to connect that knowledge to the people making the decisions and the government’s money.

The Settlement Began With a Former Employee

A former Advanced Homecare employee filed the qui tam case that led to the settlement. The Justice Department said the whistleblower would receive a share of the recovery. The company agreed to resolve the allegations about its neurocare protocols and Medicare billing. The Department of Health and Human Services Office of Inspector General and assistant U.S. attorneys investigated the case, according to the announcement from the U.S. Attorney’s Office for the Middle District of Florida.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. The law’s recovery-sharing provisions give an insider a financial stake in exposing false claims.

When the Record Is Made to Fit the Bill

Other home health cases show how patient eligibility and physician records can be made to fit an agency’s billing. In a separate whistleblower complaint against Amedisys, a nurse alleged that the company tried to conceal patients’ mobility by telling them to stay home:

The allegation turns the clinical question upside down. The patient was allegedly told to change behavior to fit the certification the agency wanted to make. In Advanced Homecare, the government alleged that marketers used access to the practice’s files and signature stamps to get around the certification requirement. Both accounts put the agency’s influence over eligibility records at the center of the billing story.

The government made a different record-manipulation allegation against Great Lakes Home Healthcare Specialists. In its complaint describing altered physician certifications, it alleged that an employee used correction fluid to change signature dates, uploaded the altered records and deleted the originals. The similarly named Advanced Professional Home Health Care reached a separate settlement over altered physician dates allegedly used to support Medicare payment.

You Saw How the Orders Were Signed

If you worked in the agency or the referring practice and saw marketing staff shape patient referrals or physician approvals, talk with our whistleblower experts about what happened. We work alongside you to build your strongest case from that inside knowledge and bring in home health fraud whistleblower lawyers who understand Medicare certification and billing. Your account of who controlled the records belongs at the center of that work, from our first conversation through the case.