Charter Home Health: Referral Payments and the Agency’s Civil Settlement

In the Charter Home Health fraud settlement, the Baton Rouge healthcare agency agreed to pay $1.7 million to resolve allegations that it paid for Medicare patient referrals through its officers. For someone working in intake, marketing or billing, the important connection is between the person paid to bring patients in and the agency that billed for their care. You may know one side of that arrangement from the work you do every day.

The Justice Department announced the civil resolution on July 21, 2017. It covered Charter Home Health and its two officers and included a corporate integrity agreement focused in part on proper billing and reimbursement claims.

What the Justice Department Said Charter Paid For

The government alleged that Charter, through its officers, paid a referral recipient and others for patient referrals from 2006 through 2012, violating Medicare’s anti-kickback provisions. The civil complaint sought relief under the False Claims Act.

The officers’ place in the allegation matters. The government described payments made through the people running the agency, and the resolution covered those officers as well as Charter. For an insider, the useful questions are direct: who approved the payment, and what was it for? The payment record shows where money went. Someone inside the agency may know why it went there.

That is the central question in home health patient recruiter fraud: what was the business paying someone to deliver? In Charter’s case, the government’s answer was patient referrals. We see the wrong in that alleged bargain: an agency gets the patient, the referrer gets paid, and Medicare gets the bill. The patient becomes the merchandise.

Why Referral Payments Reach the Medicare Claim

A referral brings the patient to an agency. The clinical and billing records carry that patient through to a request for Medicare payment. Understanding the home health certification chain helps connect a payment for access to the business it produced.

A referrer connects the patient with care. The certifying practitioner addresses eligibility and the plan of care. The agency’s assessment describes the patient’s condition and care needs, and visit documentation records the services. Billing draws on those records to submit the claim. Each step gives an insider a different view of the same patient.

At the other end, Medicare’s Claims Processing Manual describes the claim and payment process. The remittance shows what Medicare actually paid after adjustments. We connect the payment arrangement to the patient, the claim and that payment record, so the case follows the money through the agency.

Needed Care and Paid Referrals Are Separate Questions

A referral-payment case can reach patients who needed home health services. The question goes beyond whether the care was medically necessary to the financial arrangement around it.

In a separate physician’s criminal case involving Grand Home Health Care, the Seventh Circuit’s opinion described payments of $400 for new-admission certifications and $300 for recertifications. Patients needed home health care and chose agencies independently. The court nevertheless treated those paid certifications as referrals.

The physician controlled a document the agency needed to obtain payment. That makes this parallel useful to someone who sees signed forms but never sees a patient being steered at intake. The paid step can be the signature that allows the agency to bill. A clinical file showing a need for care answers a different question from a payment record showing who was paid to authorize it.

What Charter’s Corporate Integrity Agreement Addressed

Charter agreed to enter a corporate integrity agreement promoting compliance with Medicare and other federal health care program requirements. The Justice Department specifically identified proper billing and submission of reimbursement claims among its subjects.

The settlement reached beyond the referral payments themselves to the agency’s billing practices. For an employee who knows the claims side of the business, that is a reason to speak up even if someone else handled the referral arrangement.

The Referral Recipient’s Separate Benefits Case

The Justice Department’s settlement announcement also reported a referral recipient’s conviction for Social Security benefits fraud. Its account of that criminal case said the recipient concealed Charter referral payments from the Social Security Administration to keep receiving disability income. She received $152,627 in benefits for which she otherwise would not have qualified.

That was benefits money paid to the recipient, separate from Charter’s civil settlement. The connection was the referral income: money paid by the agency became income the recipient hid to keep another government payment coming. We see more than a questionable expense at the agency. The same referral payments figured in a second drain on public funds.

What Evidence Is Needed to Prove Fraud?

For a home health referral-payment case, the useful evidence connects the compensation, the patient referred and the agency’s claims. We work with the insider who can explain what triggered payment, who approved it and how the referred patients entered the agency’s business.

An intake employee may recognize the patients associated with a referral source. Someone handling payments may understand the arrangement behind the expense. A billing employee may know the claims and remittances. Those are different pieces of the same account, and the details that look routine to one department may explain the transaction to another.

The useful distinction is between a payment’s label and its purpose. A person processing an expense may know its description, while an intake employee knows which referral source sent the patients. We assess that knowledge together, including whether compensation followed admissions or the paperwork needed for billing. The business explanation matters as much as the entry in the books.

Our work is to connect that firsthand knowledge to the records and decisions that support a whistleblower case. The starting point is the part of the business you know.

How Much Does a Medicare Fraud Whistleblower Get Paid?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. We connect your firsthand knowledge of referral payments to the records and decisions behind the agency’s claims.

You Know Why the Referral Was Paid

If you know who paid for home health referrals or how those patients reached billing, speak to one of our Whistleblower Experts about what you saw. We build the case with you and bring in home health fraud whistleblower lawyers who understand agency referral arrangements and Medicare claims. From the first conversation through the pursuit of a recovery, we stay beside you to build your strongest home health whistleblower case.