Atlantic Home Health and Victory: False Visits in the Energy-Worker Benefit

Atlantic Home Health and Victory’s DOL fraud settlement resolved allegations of false home visits and payments for patient referrals, with Atlantic agreeing to pay $9,990,944. A former corporate administrator who worked at Atlantic Home Health Care and its predecessor, Victory Medical Solutions, brought the whistleblower claims included in the settlement. If you know who actually went into the home, or what the agency offered to get the patient, this case speaks to both sides of that business.

The Justice Department announced the agreement on January 5, 2024. Atlantic operated in Arizona and eight other states. The settlement amount reflected the company’s financial condition.

The Energy Employees Program Atlantic Allegedly Billed

The Energy Employees Occupational Illness Compensation Program pays for healthcare for Department of Energy employees and contractors with occupational illnesses. The Department of Labor administers it through its Office of Workers’ Compensation Programs. Atlantic’s alleged false claims concerned in-home nursing and personal care under this benefit.

False Visits With No Employee in the Home

The United States alleged that, from 2017 through 2021, Atlantic billed the Energy Program for in-home nursing and personal care when its employees were not physically present in patients’ homes. A home visit without anyone visiting.

The whistleblower’s complaint describes the care business as Haven and alleges that telephone calls stood in for home health care visits. It puts the time on the phone beside the time billed:

The complaint also alleges that Haven billed for all the nursing hours the Department of Labor authorized, regardless of whether a nurse was available or that much care was delivered. An authorization became the amount on the bill, according to the whistleblower, even when staffing could not supply the care.

For someone who knows the staffing, the question is concrete. Which employee was supposed to be with the patient, and what did the agency bill for that time? A scheduler’s account of an assignment and a worker’s account of the visit can speak to different parts of the same claim. We connect what an insider actually knows about attendance to the service the agency represented to the payer.

Fictional Charts for Visits That Never Happened

The complaint alleges that Haven filled gaps in a patient’s nursing records with fictional visit templates using measurements and observations from other patients’ charts. The patient had threatened to leave because most nursing care came by telephone. The whistleblower described how the paperwork concealed the missing visits:

The alleged failure reached the patient, too. The complaint describes a patient who fell at home and lay without treatment for hours while no nurse or family member was there. Haven’s bill placed a nurse in the home during that period, the whistleblower alleged, while the incident report and emergency-room records told a different story.

Referral Benefits Through Friends and Family

The government also alleged that Atlantic paid cash of up to $5,000 for patient referrals through its “friends and family program.” It described additional in-kind payments to patients and their families for food, internet, travel and other expenses.

We call that buying referrals. A friendly program name does not change the government’s allegation.

This is the patient recruitment side of the case. Someone who knows the arrangement may recognize the purpose of a payment that looks unremarkable in an expense account.

The complaint gives the family arrangements another dimension. It alleges that Haven put some patients’ relatives on its payroll to provide care in place of nurses. The whistleblower described untrained relatives and aides giving medications, changing dressings and reporting observations to a nurse by phone. That connects who received the money with who actually delivered the care represented on the bill.

The visit allegation and the referral allegation reach different decisions inside an agency. One concerns the work represented on the bill. The other concerns what brought the patient to the business. We look at who received the benefit, what referral it was tied to and how the resulting care was billed.

Atlantic, Victory and the Administrator Who Saw Both

Victory Medical Solutions was Atlantic’s predecessor. The whistleblower had worked for both businesses as Corporate Administrator and Director of Human Resource Administration and Management, from September 2017 through January 2020.

A worker in a patient’s home sees the visit. An administrator may understand who was employed, who directed the work and how the business described its staffing. In the complaint, the whistleblower alleged that Victory’s patients and employees were transferred to Haven while billing to the Department of Labor continued. Her work crossed both company names.

Disclosure of the Referral Program and the Settlement

The Justice Department said Atlantic voluntarily disclosed matters concerning its friends-and-family program and in-kind payments to patients and families to the Department of Health and Human Services Office of Inspector General. It did so before the United States told Atlantic about its investigation. The government acknowledged that cooperation in the settlement agreement.

Atlantic’s disclosure concerned the referral arrangements. The civil settlement also included the former employee’s whistleblower claims. We examine what the business told the government alongside what the employee knows about the services and payments.

United Energy Workers Healthcare and Inflated Care Time

United Energy Workers Healthcare paid $9 million in a separate settlement over alleged false claims to the same Department of Labor benefit. The government’s February 7, 2023 announcement described services that were never provided or were medically unnecessary.

The government alleged that the company billed for case management it did not provide and instructed caregivers to charge for more time than they actually spent with patients. It also alleged billing for services outside the program’s coverage and providing services without required licenses. Multiple whistleblowers brought claims included in the resolution.

The parallel is the gap between time with the patient and time on the claim. Atlantic’s alleged false visits concerned employees who were not physically present. United Energy Workers’ alleged instructions concerned charging for more time than caregivers spent. An insider may know where those accounts diverge: the visit itself, the instruction about time or the claim that followed.

What Evidence Is Needed to Report Fraud?

For the Atlantic practices, the useful evidence connects employee attendance and referral benefits to particular Energy Program claims. We work with your knowledge of the visits and payments to identify the difference between the care represented and the care delivered.

The complaint’s allegations about rotating chart templates show why a complete-looking file can conceal missing care. Someone handling referrals may know why a family received a benefit. Someone handling staffing may know whether the assigned employee went to the home. Someone handling billing may know which service and time reached the claim. Those are starting points for a conversation with us about the conduct you saw.

The Whistleblower Reward in the Atlantic Case

The Justice Department said the former administrator would receive approximately $1.7 million as part of Atlantic’s resolution. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know Who Was in the Home

If you know the staffing behind an Energy Program bill or the payments behind a referral, speak to one of our Whistleblower Experts about the visits and referrals you saw. We build your strongest home health whistleblower case around your knowledge and bring in home health fraud whistleblower lawyers who understand federal benefit billing and referral payments. We stay beside you as the case develops, connecting what you saw inside the business to the bills sent to the government.