Texas-Based Home Healthcare Facilities Work Together to Defraud Medicare

False Claims Act , Healthcare Fraud

In what is being called the “largest criminal health care fraud takedown in the history of the Department of Justice,” three separate home healthcare facilities were found to have been separately billing Medicare for the same services – which were oftentimes not provided or medically necessary – resulting in the government program paying over $40 million in fraudulent claim reimbursements.

Over the course of the four-year scheme, a team of doctors ran the facilities as though they were separate entities; it was later found that they were instead working as one, even employing the same individuals and effectively billing Medicare multiple times for services that were not rendered. The companies, US Physician Home Visits, A Good Homehealth, and Primary Angel Inc., all employed the same deceptive tactics in an attempt to receive reimbursements to which they were not entitled; among these tactics, they would regularly certify patients as though they necessitated home health services when they instead required a much lower level of care. During trial, it was revealed that over 97% of Medicare patients treated by US Physician Home Visits were provided with home healthcare, regardless of necessity.

In addition, the facilities would then bill for the highest level of care regardless of what was actually provided; in many instances, they would submit claims for a ninety-minute comprehensive physician examination when the visit only lasted a mere twenty minutes. In each false claim submitted, the facilities utilized one doctor’s Medicare provider number regardless of who performed the examination – in doing so, falsely certifying themselves as reputable providers. These dishonest practices escalated so quickly that, in one case, the doctor in question submitted claims which would have required him to have worked 205 hours in a single day.

Because the relationship between the three companies was far from ethical and not permitted under federal standards, the ownership of each was deliberately concealed, going so far as purchasing the company through a “straw buyer” in order to mask the blatant collusion that was taking place. Had Medicare been aware of the nature of their cooperation, the program would be quick to revoke any authority that would allow any of the facilities to submit claims for reimbursement.

Overall, Medicare saw a loss of over $40 million; these funds were recovered following the suit, during which the doctors and billing specialists who masterminded this scheme were ordered to pay well over the stolen amount in restitution and fines. Unfortunately, the recovery alone does little to remedy the fact that home healthcare fraud cases are growing, and quickly. All too often, these schemes go undetected due to the nature of the care provided and the caution taken by those who conspire to commit them; therefore, the genuine necessity for individuals who choose to so nobly bring forward information cannot be overstated enough.

Whistleblower Justice Network Can Help You

Whistleblower Justice Network partners with whistleblowers who prioritize moral responsibility over financial gain in an effort to bring those who defraud government healthcare programs to justice.

If you have meaningful information regarding home healthcare fraud that you believe is in violation of the False Claims Act, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.

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