Home health enforcement efforts have been on the rise in 2021, especially over the past couple of months.
There have been developments with at least two multi-million-dollar fraud schemes, with the watchdog arm of the U.S. Department of Health and Human Services (HHS) also releasing findings from a large hospice-related audit.
On July 15, federal authorities announced that the owners of ANG Health Care Inc., Excel Home Healthcare Inc. and Excel Hospice Inc. pleaded guilty to one count of conspiracy to commit health care fraud as well as one count of conspiracy to pay and receive health care kickbacks.
According to the U.S. Department of Justice (DOJ), the owners paid and directed others to pay kickbacks to multiple individuals for referrals from July 2015 through April 2019. In total, the kickbacks meant that the home health and hospice agencies submitted over 8,000 claims to Medicare, which paid roughly $31 million for those services.
As part of the guilty plea, one of the owners agreed to pay more than $2.5 million in restitution to HHS and forfeit that same amount to the U.S. government.
The California case came roughly two weeks after a federal grand jury returned an indictment charging the former COO and CFO of United Home Care Inc. and Trinity Home Health Care with one count of conspiracy to commit bank fraud and four counts of bank fraud.
In a July 2 announcement, DOJ alleged that, from April 2016 until March 2017, the home health execs were involved in a scheme to defraud Origin Bank, Peoples Bank and Louisiana National Bank (LNB) by fraudulently obtaining money and credits from the institutions.
“It is alleged that [they] orchestrated and executed a check kite between accounts at Origin Bank and LNB, wherein they deposited hundreds of checks between multiple accounts they controlled at both banks and took advantage of the float when they passed the checks, timing the exchanges to artificially inflate the account balances,” DOJ’s announcement reads. “In so doing, [they] caused Origin Bank and LNB to honor checks and payments drawn against accounts with insufficient funds and put the financial institutions at risk.”
An indictment is an accusation, and a defendant is presumed innocent unless and until proven guilty beyond a reasonable doubt, DOJ was careful to note.
Meanwhile, also in July, the HHS Office of Inspector General (OIG) released findings from a Medicare audit of a San Mateo, California-based home health and hospice provider. Following an audit of 6,142 claims, OIG found that the provider received an estimated $10.5 million in unallowable Medicare reimbursement for hospice services that shouldn’t have been rendered.
OIG came up with that total after reviewing a random sample of 100 claims and finding that 34 did not comply with Medicare requirements.
“Specifically, for 33 claims, the clinical record did not support the beneficiary’s terminal prognosis, and for one claim, the clinical record did not support the level of care billed to Medicare,” OIG described. “In addition, for a few claims, there was no evidence that beneficiaries elected hospice care before the periods covered by the sampled claims, or there was no support for physician services billed to Medicare.”
The provider challenged the bulk of OIG’s findings.
In addition to the DOJ and OIG developments, the Department of Labor (DOL) announced it had taken actions against a Harrisburg, Pennsylvania-based home health care company, recovering $1.5 million in back wages for nearly 250 workers.
A DOL investigation found that Neoly Home Care LLC “manipulated pay rates to create the appearance that they paid overtime when employees worked more than 40 hours in a workweek.” In reality, the company paid employees approximately the same rate for all hours worked.
“Many workers in this industry depend on their wages just to make ends meet, so actions like those taken by Neoly Home Care are especially harmful,” DOL Wage and Hour Division Acting Administrator Jessica Looman said in a statement. “Employers that violate the law also gain an unfair competitive advantage over law-abiding employers.”
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