Late Thursday, DoJ filed and announced a false claims act complaint against Vitas, the hospice business owned and operated by Chemed Corp, whose other business is septic tank cleaning giant Roto-Rooter. According to the government’s complaint Vitas systematically billed Medicare for terminal care for people who were not dying — even in such instances where Vitas’s own documentation stated a patient was “very healthy given her age.”
The most troubling aspect of the conduct that DoJ alleges Vitas committed is that in order to present false claims for hospice services, Vitas would have had to convince patients and their families to believe that they were dying when they really were not — just so that it could bill Medicare. According to the government’s complaint, Vitas may have received as much as a billion dollars or more per year from Medicare for hospice service claims.
Frohsin & Barger client Michael Rehfeldt, a former executive director for Vitas, complained that Vitas encouraged its clinical staff to admit as many patients as possible without any genuine regard for their diagnosis, and that Vitas rigorously tracked its daily Medicare patient census and enforced strict admission quotas. Ultimately, Rehfeldt filed a federal qui tam complaint about Vitas’s allegedly fraudulent practices and together with his attorneys at Frohsin & Barger cooperated with the government investigation– leading to DoJ’s lawsuit against the company. In April, Rehfeldt’s qui tam suit was voluntarily dismissed preserving the right to re-file if necessary and making way for DoJ to prosecute the alleged fraud in the present suit.
“The Medicare hospice benefit is intended to provide patients nearing the end of life with pain management and other palliative care to make them as comfortable as possible,” said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division. “Too often, however, we hear reports of companies that abuse this critical service by using aggressive marketing tactics to push patients into services they don’t need in order to get higher reimbursements from the government.”
Read a copy of the False Claims Act complaint against Vitas here: United States v. Vitas Hospice Services, et al.
In a prepared statement announcing his office’s first False Claims Act whistleblower settlement, United States Attorney for the Middle District of Alabama George Beck praised Frohsin & Barger attorneys and their client for bringing to light allegations of false claims to Medicare for unnecessary home health services in the case of United States ex rel. McDonald v. Techota, LLC, et al., 11-cv-00366, (MDAL).
“Our office is grateful to the law firm of Frohsin and Barger who represented [the whistleblower] and brought this injustice to our attention,” stated U.S. Attorney Beck. “Our country needs those with knowledge about the fraud and false claims to realize that if they bring these injustices to our attention, we will diligently work to cure the injustice.”
According to the government’s press release and court documents, the settlement resolved claims that home health care provider Techota, LLC, “billed Medicare for home health services that were not eligible for reimbursement because the services were not medically reasonable and necessary or were not provided under a valid plan of care.”
Pursuant to the settlement documents, Techota, LLC will also enter into a Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services in an attempt to prevent future fraud. U.S. Attorney Beck also noted the efforts of Assistant United States Attorney Jim DuBois and Department of Justice trial attorney Natalie Priddy for their work on the case. Frohsin & Barger joins in praising the efforts of attorneys Priddy and DuBois as well as HHS-OIG Special Agent Derrick Jackson and his team for their dedication in pursing the case on behalf of the United States and helping to preserve the integrity of the Medicare program.
Thanks to a False Claim Act case filed by former employee Ellen Momeyer, Hospice of Arizona L.C. has agreed to pay $12 million to the United States to settle hospice fraud allegations. Ms. Momeyer filed the case in 2010, alleging that Hospice of Arizona admitted and billed for patients who it knew were not terminally ill. After investigating her allegations, the United States agreed, finding that the hospice pressured staff to recruit Medicare patients and made it difficult to discharge patients who longer qualified for the hospice benefit. As a result, the Department of Justice contended, the hospice knowingly submitted false claims for hospice care to the federal government through the Medicare program administered by the US Department of Health and Human Services (HHS). Hospice of Arizona L.C. is owned and operated by parent company American Hospice Management Holdings LLC.
Glenn R. Ferry of HHS’s Office of Inspector General said, “Medicare and taxpayers depend on hospice agencies to provide medically appropriate services to terminally ill patients. When providers place more importance on the bottom line than on the care of these vulnerable patients, they can expect to face serious penalties.”
As part of the settlement, Hospice of Arizona will be required to enter into a Corporate Integrity Agreement with HHS. Ms. Momeyer will receive a $1.8M reward for her contributions as a whistleblower.
Beverly Cooper could spend 10 years in prison for enabling her employer to bilk more than $24 million out of federally funded healthcare programs. Cooper, a registered nurse, pleaded guilty friday to “fabricated nursing visit forms” which caused Reliance Home Care, LLC, First Choice Home Health Care Services, Inc. and Accessible Home Care, Inc. “to submit claims to Medicare for services that were not medically necessary and/or not provided,” according to a DoJ press release.
Home Health nurses and others who provide services for Medicare patients risk not only their coveted licenses but also the chance that they will end up behind bars when they comply with their employers’ instructions to falsify medical charts.
Conversely, if they report what they know to Medicare, then they could not only protect their licenses and liberty but also may receive an award. Had Cooper come forward instead of participating in the fraud, she would likely be entitled to between $3,600,000 and $6,000,000 for her information instead of going to jail — because qualified whistleblowers under the qui tam sections of the federal False Claims Act are entitled to no less than 15% and no more than 25% of the damages and penalties in cases pursued by the federal authorities.
Tennessee -based Home Health provider Techota, LLC — which owns home health companies, including Cahaba Valley Home Health, operating in rural Alabama — has agreed to enter into a corporate integrity agreement with the Department of Health and Human Services and an ability-to-pay settlement, including reimbursement of attorneys’ fees and costs, according to settlement documents filed in the U.S. Court for the Middle District of Alabama. The settlement resolves an almost two-year investigation into the company’s business practices that began with a whistleblower lawsuit, United States ex rel. McDonald v. Techota, LLC, et al., 11-cv-00366, filed by Frohsin & Barger in May of 2011.
According to the original whistleblower Complaint, the lawsuit involved allegations that Techota and its subsidiaries Cahaba Valley Health Services and Cahaba Valley Home Health caused false claims to be submitted to Medicare for patients who were not home bound and did not require home care. Among the more egregious examples alleged in the complaint, was a patient who requested that the home health nurses visit him at his job because he was too busy to be home every time nurses came to provide treatment. “As the name implies, home health services are reimbursed by Medicare only for patients who can’t leave home without considerable effort.” said whistleblower attorney Jim Barger. “In other words, Medicare won’t pay a company for home health services for someone who is down at the local auto parts store everyday.”
Medicare regulations also require that home health patients require at least part-time skilled nursing care or therapy and be under an established plan of care periodically reviewed by a physician and the qualified home health company. Court documents paint a picture of wasted home health visits, alleging instances where nurses did little more than deliver cigarettes to people and sit with them watching television. “The allegations of waste and abuse settled in this lawsuit offer one explanation why our Medicare dollars are so rapidly deteriorating while the need for quality health care is rapidly expanding,” said Henry Frohsin. “Frohsin & Barger commends United States Attorney George Beck, Assistant United States Attorney Jim DuBois, and Department of Justice trial attorney Natalie Priddy for tackling this case and bringing it to resolution.”
According to the settlement documents, Techota will repay a portion of the alleged false claims pursuant to its ability to pay, reimburse attorneys’ fees and costs, and implement safeguards to prevent future false claims. The settlement documents further provide that if Techota breaches the agreement it could be forced to forfeit any undisclosed assets and pay as much as $4.1 million plus penalties and interest.
An Illinois jury has returned a $29M verdict against Momence Meadows Nursing Center, Inc. (Momence) for providing substandard care to its Medicare patients. Two former employees of the company brought the case as whistleblowers under the False Claims Act. The nurses alleged that the care at the facility was so poor that it was essentially worthless and, therefore, Medicare should not have paid for it.
After several days of trial, the jury returned the verdict in a matter of hours, finding that the substandard care had cost the United States some $3M. Under the False Claims Act, those who defraud the federal government are liable for three times the damage suffered by the United States, plus a penalty of up to $11,000 for every false claim submitted to the government. All told, the jury found that Momence had submitted 1700 false claims and the total liability reached the $29M figure. The nurses will be entitled to between 15-30% of whatever is ultimately collected.
The case sends an important message to the nursing home community, particularly in light of today’s Office of Inspector General (OIG) Department of Health and Human Services report, publishing findings that the US paid some $5.1 billion in 2009 to nursing facilities for services that did not meet “quality-of-care” requirements. The investigation found that a disturbing percentage of Medicare patients in skilled nursing facilities do not receive the care they need.
Frohsin & Barger has represented whistleblowers across the country in False Claims Act suits against nursing facilities. Two weeks ago the Department of Justice announced a $700,000 settlement in a False Claims Act case brought by Frohsin & Barger against a skilled nursing facility in Fairfax, Virginia. Our clients received an award of $122,500.
To report skilled nursing or Medicare fraud, contact Frohsin & Barger, LLC.
Media outlets report that the United States has elected to join a False Claims Act case against beleaguered cyclist Lance Armstrong.
A few weeks ago, Armstrong ignited a media and water-cooler frenzy through his nationally televised interview with Oprah Winfrey, in which Armstrong dryly admitted to a sophisticated doping program spanning his entire career. Whetting the nation’s appetite for the drama and adding somewhat to the debate was a January 14, 2013 Wall Street Journal report that the Department of Justice was deliberating over intervening in a False Claims Act case filed against Armstrong and his former cycling team by Armstrong’s former teammate and fellow disgraced doper, Floyd Landis (though Landis evidently still denies culpability).
Shortly thereafter, on January 17, the New York Daily News leaked a copy of the sealed complaint, available here. Readers of this blog will be familiar with the False Claims Act (FCA), which allows private citizens – in this case Landis – aware of fraud against the federal government to file suit on the government’s behalf. In his suit, Landis alleged that Armstrong and his team defrauded their sponsor, the U.S. Postal Service (USPS), by knowingly violating terms in the sponsorship agreement that required compliance with the anti-doping rules. In other words, Landis alleged that Armstrong lied to the USPS about his doping and, had the USPS known what he was doing, it would never have paid him sponsorship money. Under the “treble damage” provision of the FCA, that would mean Armstrong could owe the United States three times the amount he and his team had received – around $100 million, according to the Wall Street Journal.
One of the major questions raised by the timing of this revelation and the Oprah interview was why Armstrong would choose to make a public confession now, particularly with this lawsuit pending. According to information reportedly derived from sources close to the DoJ investigation, the Department had closed the inquiry at one point in February 2012 – apparently only to revive it later. Even in the days before the interview, WSJ and the Daily News reported that DoJ was on the fence about intervention. So why would Armstrong tug on Superman’s cape at this point by admitting the substance of the factual allegations in Landis’s complaint? Having ardently and consistently denied the fact of his doping for years, why stop now and expose himself to massive liability?
Many – including writers of this blog – speculated that Armstrong might have already been negotiating a settlement with DoJ and that his lawyers were confident the confession would not materially alter those negotiations.
It now appears that is not the case. USA Today reports that the United States has elected to intervene in Landis’s case and pursue a judgment against Armstrong. Based on the comments offered by Armstrong’s legal representatives, it appears he plans to rely on somewhat technical legal arguments in attempting to evade liability. This only seems to deepen the mystery of why Armstrong chose January 2013 as the time to come clean about his activities and, in the process, concede the factual basis for what could be a crippling federal lawsuit.
Frohsin & Barger represents whistleblowers nationwide under the False Claims Act and the IRS and SEC whistleblower programs. To report fraud against the government, contact Frohsin & Barger.
The United States and the State of New Jersey have announced a $12.6 million dollar settlement with Cooper Health Systems and Cooper University Hospital (“Cooper”). Whistleblower Dr. Daniel DePace filed a qui tam False Claims Act suit in 2008, claiming that hospital operator paid bribes to physicians in exchange for patient referrals. According to Dr. DePace’s complaint, the doctors were paid thousands of dollars to participate in what amounted to a sham “physician advisory board.” In reality, Dr. DePace alleged, the physicians were not expected to provide any service in exchange for the money, other than the referral of patients to the hospital.
The federal Anti-Kickback Statute and its state equivalents are designed to protect patients’ rights to receive impartial medical judgment by prohibiting the offer or acceptance of any remuneration in exchange for patient referrals. Dr. DePace alleged that the kickback system designed by Cooper influenced doctors to refer patients based not on the patients’ best interest, but on the illicit financial relationship between Cooper and the doctors.
To report anti-kickback violations or Medicare fraud, contact Frohsin & Barger.
According to a federal indictment unsealed yesterday, four home health agencies in Detroit and Chicago schemed to bilk $22M out of the Medicare system before authorities stepped in to stop them. The scheme involved billing Medicare for home health services that were unnecessary or never performed and in some instances bribing beneficiaries for their billing information. The companies implicated were: Royal Home Health Care Inc., Prestige Home Health Services Inc., Platinum Home Health Services Inc., and Empirical Home Health Care Inc. An FBI statement lists the individuals charged and the various allegations:
Muhammad Aamir, 42; Usman Butt, 39; Hemal Bhagat, 31; Syed Shah, 50; Tariq Tahir, 46; and Raquel Ellington, 56, of the Detroit area; and Tayyab Aziz, 43, from the Chicago area, each are charged with conspiracy to commit health care fraud. All but Aziz are also charged with health care fraud and with conspiracy to violate the Anti-Kickback Statute. Butt, Bhagat, Shah, and Aziz are additionally charged with conspiracy to commit money laundering.
With nearly 80,000 visits from over 80 countries, FraudBlawg remains an important online resource for original content about False Claims Act qui tam litigation, healthcare fraud, and other government investigations. Since its inception, the law blog has received favorable reviews by WordPress, and 2012 was no exception. Below are excerpts and links to the 2012 review:
4,329 films were submitted to the 2012 Cannes Film Festival. This blog had 25,000 views in 2012. If each view were a film, this blog would power 6 Film Festivals.
The busiest day of the year was February 8th with 1,501 views. The most popular post that day was: Former Inspector General Agent: TeenScreen Is “Dragnet for Pharmaceutical Industry”.
These are the posts that got the most views in 2012: