Maxim Healthcare: Real Signatures on Fake Time Cards

The Maxim Healthcare fraud settlement required approximately $130 million in civil payments to resolve allegations of billing for care never provided, improperly documented services and care from unlicensed offices. The criminal complaint accused Maxim of submitting more than $61 million in fraudulent billings for services not rendered or otherwise not reimbursable. For someone who knows the schedules, the caregivers or the billing, the criminal admissions reveal how employees manufactured the records: signatures moved from real time cards to fabricated ones, nursing visits existed only on paper, and claims concealed which office actually supervised the care.

The Justice Department announced the resolution on September 12, 2011. Maxim Healthcare Services, Inc., based in Columbia, Maryland, operated hundreds of offices across the country. Its civil agreements resolved Medicaid and Veterans Affairs billing allegations. A separate criminal deferred prosecution agreement carried the company’s acceptance of responsibility, while individual guilty pleas exposed how employees manufactured the supporting records.

What the Maxim Healthcare Fraud Settlement Covered

The civil settlement covered allegations that Maxim billed for services that were not rendered, services that were not properly documented and services performed by 13 unlicensed offices. These allegations reached different parts of the same business: the care, the documents supporting the claim and the office through which the company billed.

The criminal complaint described conduct from 2003 through 2009. During that period, the Justice Department reported, Maxim received more than $2 billion in government health care reimbursements across 43 states. The allegedly false billings sat inside a much larger stream of program payments.

Home care involves several kinds of work. Medicaid finances skilled home health as well as personal care, and the workforce includes nurses, home health aides and personal care attendants. A time record describes attendance. A credential file describes the worker’s qualifications. A nursing-supervision record describes a separate check on the patient and the care. Maxim’s criminal case showed how each could be made to tell the story needed for billing, regardless of what happened in the home.

How False Time Cards Became Medicaid Bills

In their guilty pleas, an account manager and a recruiter from Maxim’s Tempe, Arizona office admitted creating fraudulent time cards to bill government programs. The Justice Department’s account gives the physical detail that makes the scheme unmistakable:

The signature was real. The document it appeared to authenticate was fabricated. That matters to a caregiver who recognizes their signature but knows the hours beside it are wrong, and to a billing employee who sees the finished time card without seeing how it was assembled.

A home health aide and personal care assistant from Maxim’s Charleston office admitted in his guilty plea that he fabricated time cards at other employees’ direction. The Justice Department reported that Maxim repeatedly billed Medicaid from cards showing him working more than 24 hours in a day.

We do not need an elaborate theory to see the absurdity. The billing demanded a day longer than the calendar allowed.

The criminal pleas also exposed a payment arrangement outside the office. A licensed practical nurse and a pediatric patient’s mother admitted submitting bills through Maxim as though the nurse had cared for the child when she had not. They split the money the nurse received. The Justice Department reported that Maxim received more than $70,000 from Florida’s Medicaid program through that arrangement.

Credentials and Nursing Visits Manufactured on Paper

The employee guilty pleas described falsified caregiver credentials and supervisory visits as well as invented hours. A regional account manager admitted forging CPR cards to make caregivers appear properly credentialed. He said he learned the practice from supervisors when he joined Maxim and that people under him continued it when he moved into leadership.

That is a revealing account of how a practice travels inside a business. The credential file was supposed to document a caregiver’s qualifications. According to the manager’s plea, supervisors instead taught employees how to manufacture that appearance.

In her guilty plea, the director of clinical services at Maxim’s Cherry Hill, New Jersey office admitted fabricating records to make it appear that other nurses had performed required supervisory visits. Those visits were supposed to bring a registered nurse into the home to check the patient’s condition and the care provided by home health aides.

She said her superiors expected all supervisory visits to be completed without giving her adequate resources. On paper, the visits were done. The patient had received no such nursing check. For a clinical supervisor, the difference between a completed form and a completed visit is the heart of this part of the case.

Why the Unlicensed Offices Mattered

Maxim’s criminal complaint described billing through licensed offices for care actually supervised by unlicensed offices. It also described concealing the unlicensed offices from government auditors and investigators. The claim presented one office while the work belonged to another.

In his guilty plea, a regional account manager admitted that Maxim’s Gainesville, Georgia office operated without a license and that he and others directed its bills through a licensed office so Medicaid would approve reimbursement. When employees believed a state regulator would visit, lower-level staff were directed to give false information to keep the unlicensed operation concealed.

State licensing authorities control permission to operate. State Medicaid agencies and their managed-care payers control enrollment, authorization and payment. The Maxim account connects those responsibilities in a concrete way: the office represented on the bill helped hide the office actually supervising the care.

A different regional account manager admitted in his guilty plea that he knowingly gave false information to a Texas Medicaid surveyor investigating an unlicensed Houston office. Licensing staff, clinical managers and billing employees could therefore see different pieces of the same concealment. The office name on a claim mattered because it represented where the government understood the service to come from.

The Civil Agreements and the Company’s Criminal Admissions

Maxim entered a deferred prosecution agreement in its criminal case and separate civil settlement agreements. Under the criminal agreement, the company accepted responsibility and admitted the facts set out in the criminal complaint. The Justice Department reported pleas by eight former Maxim employees and a former patient’s parent.

The company’s response also reached management. The Justice Department said Maxim terminated senior executives and other employees it identified as responsible, filled leadership positions in compliance, clinical operations and quality, and substantially increased compliance resources. It credited the company’s cooperation and reforms in deciding to enter the deferred prosecution agreement.

Those changes make more sense beside the account from the Gainesville regional manager’s plea. He described demands for dramatic growth without market analysis, regardless of market conditions. The clinical supervisor described expectations without the resources to meet them. In those accounts, management demanded the result and employees fabricated the records that made it appear accomplished.

The Whistleblower Case and Reward

The civil settlement arose from a whistleblower’s False Claims Act lawsuit. The Justice Department announced that the whistleblower would receive approximately $15.4 million from the federal and state recoveries. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

The HHS Office of Inspector General, the FBI and the Veterans Affairs Office of Inspector General jointly investigated Maxim’s conduct. The civil agreements addressed Medicaid and Veterans Affairs billing, while a separate criminal agreement carried the company’s acceptance of responsibility.

What Evidence Is Needed to Prove Fraud?

For the practices described in Maxim’s case, the evidence connects actual care to the time cards, qualifications, supervision records, office identity and claims used to obtain payment. We examine who created or changed those records, who directed the changes and how they reached the payer. The employee who knows how a false document was produced may explain something a finished billing file conceals.

The same underlying mismatch appears in At Home Care Group’s civil settlement. The government alleged that the company altered caregiver schedules and billed Oregon Medicaid for in-home medical and nonmedical care that workers had not performed. The parallel is a schedule changed to support payment for missing care.

In a personal-care advisory issued in 2016, the HHS Office of Inspector General described pre-signed time sheets, overseas travel and purported services in simultaneous locations. Its point was that documents can agree with each other while concealing care that never occurred. Maxim’s pasted signatures show exactly why someone familiar with the work can see through a file that appears complete.

A caregiver may know which visits happened. A clinical supervisor may know which nursing checks were fabricated. An office or billing employee may know why claims carried another location’s identity. We bring those perspectives together with the claims and payments to develop the whistleblower case around what the person inside the operation actually knows.

You Know Whether the Care Happened

If you saw time cards rebuilt, nursing visits invented or an office hidden behind another office’s bills, talk with our whistleblower experts about what you saw. We work with you to build your strongest home health whistleblower case, bring in home health fraud whistleblower lawyers who understand Medicaid billing and clinical supervision, and stay beside you through every step.