Evolution Health, Guardian, Gem City, and Care Connection: Home Health Referral Benefits Before Acquisition

In the Evolution Health Guardian Gem City referral settlement, the companies, including Care Connection of Cincinnati, agreed to pay $4,496,330 to resolve allegations that they bought Medicare referrals with lease payments, wellness services, sports tickets, and meals. For someone who worked on the facility contracts or wellness services, the question at the center of this case is familiar: what did the agency expect in return?

Guardian Health Care, Gem City Home Care, and Care Connection of Cincinnati provided home health services in Texas, Ohio, and Indiana. Evolution Health owned the agencies during the period at issue. The Justice Department announced the settlement on July 1, 2024, after the businesses had changed hands.

What Is a Kickback Scheme?

A home health kickback scheme exchanges money or other benefits for referrals of patients whose care a government program pays for. In this case, the government alleged that the agencies supplied benefits to assisted living facilities, their staff and residents, and referring healthcare providers, then billed Medicare for home health services delivered to the referred patients.

The settlement agreement’s account is more revealing than a list of meals and tickets. The companies disclosed potential kickback violations involving payments to assisted living facilities to operate wellness centers and induce referrals, including residents’ self-referrals. The alleged benefits included wellness activities, first aid, and preventive health services. Those services put the referral relationship inside the place where prospective patients lived.

The government alleged that the companies expected and received referrals in exchange for those benefits from June 28, 2013 through March 31, 2022. The alleged exchange connected spending at the facilities to the agencies’ later Medicare claims.

We see the problem plainly: under the government’s account, care offered inside a resident’s community was also a means of buying that resident’s next referral. The wellness label did not tell the whole story.

The Anti-Kickback Statute addresses payments and other benefits intended to induce federally funded health care referrals. The Justice Department connected that rule to the False Claims Act through the home health claims the agencies submitted afterward.

From a Facility Benefit to a Medicare Claim

Here, the government’s allegation ran from benefits supplied around assisted living facilities and referring practices to patients entering the home health agencies and claims reaching Medicare. Home health work has further handoffs within it. A referral brings a patient to an agency. Certification addresses the patient’s eligibility and plan of care. The agency’s comprehensive assessment records the patient’s condition and needs, and the agency provides or arranges the services it bills for.

Those distinctions matter to the person who sees only part of an arrangement. A facility employee may know what the wellness center supplied and which agency residents were directed toward. An agency employee may know who approved the lease or service spending. Someone in billing may see the patients and claims that followed. We connect those accounts instead of expecting any one employee to know every part of the business.

For these allegations, we would compare the lease and service arrangements with the referral communications and the resulting claims. The useful connection is between a particular benefit, the people or facility receiving it, the referrals expected in return, and the agency asking Medicare to pay. That is how knowledge of an ordinary operating expense can become knowledge of the alleged exchange behind it.

Disclosure Before the Amedisys Acquisition

The companies themselves brought the conduct to the government on March 14, 2022, before Amedisys acquired them on April 1, 2022. The agreement identifies Amedisys, Inc. as the sole member of Amedisys Holding, which acquired Evolution Health and the three agencies.

The companies ended the conduct and helped the government investigate it, including identifying the people involved and helping determine potential Medicare losses. The Justice Department gave them credit for disclosure, cooperation, and remediation. The Justice Department’s Civil Division and the U.S. Attorney’s Office for the Southern District of Ohio handled the matter.

The Facilities and Providers on the Other Side

The agreement describes alleged benefits involving 46 assisted living facilities and 15 referring healthcare providers. Its attachment names Senior Star at The Kenwood in Cincinnati, Watercrest at Mansfield in Texas, and Franklin Morning Pointe in Indiana.

For an insider, the attachment connects the allegation to recognizable places and relationships. The more useful account is what happened at the facility you know: who arranged the services, what the agency supplied, and what was said about referrals. We use that operational detail to understand the exchange described in the agreement.

Leases and Services in Other Referral Cases

Amedisys’s separate settlement announced in April 2014 included allegations that it supplied patient care coordination to a Georgia oncology practice below fair market value to induce Medicare referrals. That allegation concerned a service supplied to a referring practice.

The parallel is the economic benefit. Supplying a service on favorable terms can give a referral source something valuable, just as making a payment can. The question for the insider is what the agency expected the recipient to do in return.

In the Village Home Care settlements announced in May 2023, the government alleged a sham medical-director arrangement with one physician and a sham sublease for unused space with another. Both arrangements allegedly bought referrals. The alleged payment for unused space made the rental explanation especially pointed: what was the agency buying if it was not using the space? Quite a rental arrangement.

Across these cases, the paperwork described leases, services, or professional duties. The allegations asked what those arrangements actually purchased. We look at the work performed, the space used, the benefits delivered, and the referrals expected in return because those details explain the transaction better than the expense label does.

What Your Knowledge of the Arrangement Can Add

In a qui tam case, an insider can connect what a wellness-center contract promised to what happened inside the business. The person who administered it may also know why the agency wanted the relationship, who approved the benefits, and how referrals figured in those decisions. We work with insiders to connect that knowledge to the home health business and its Medicare claims. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know What the Wellness Center Was For

If you know how facility benefits were tied to Medicare referrals, speak to one of our Whistleblower Experts about the arrangement you saw. We build the case around your knowledge, match it with home health fraud whistleblower lawyers who understand these relationships, and stay beside you throughout the case.