Home health providers in the U.S. have paid at least $422.6 million to settle False Claims Act (FCA) allegations since 2012, according to a recently unveiled database from Nashville, Tennessee-based legal firm Bass, Berry & Sims.
The total number of annual settlements have varied greatly, from a high of 14 in 2015 to a low of one in 2012. The overall settlement value has likewise fluctuated from year to year, with 2014’s total of $211.7 million serving as the single-largest sum over the past decade.
“We wanted to create a database of False Claims Act settlements to allow providers to have easy access to information, to see the cases that the government or regulators have resolved in the health care fraud space,” Bass, Berry & Sims Partner Brian Roark told Home Health Care News. “This is the first publicly available database of this type.”
The FCA is the government’s primary civil tool to combat fraud, waste and abuse within the health care sector. A significant percentage of all FCA cases come from whistleblower complaints.
In addition to home health providers, the Bass, Berry & Sims database collects fraud data related to hospice agencies, skilled nursing facilities, hospitals, behavioral health organizations and several other entities.
The $422.6 million in settlements from home health providers since 2012 come from at least 51 different cases, according to the database.
Enforcement efforts in the home health space are often related to questions around medical necessity and documentation, said Roark, who heads Bass, Berry & Sims’ health care fraud task force
“You see settlements where the government alleges that the provider was actually manipulating the documentation,” he explained. “Such as saying that a patient has diabetes as the primary diagnosis as opposed to something else in order to maximize reimbursement, or characterizing patients as ‘homebound’ when they actually aren’t.”
There have likewise been plenty of enforcement efforts around potentially shady sales-and-marketing practices over the past several years.
“There continues to be a lot of enforcement action around business development and marketing,” Roark said. “You see cases that involve allegations that home health providers were providing gifts, meals and entertainment to either hospital case managers or doctors, or allegations that home health companies were providing services to hospitals or doctors at below-fair-market value in exchange for referrals.”
The U.S. Department of Justice (DOJ) obtained more than $2.2 billion in settlements and judgments from civil cases involving fraud and false claims in Fiscal Year 2020. Of that, over $1.8 billion came from matters that involved the health care sector.
Home health settlements in 2020 totaled at least $8.7 million, according to the Bass, Berry & Sims database.
As of May 4, home health settlements in 2021 have totaled slightly more than $330,000.
Government watchdogs cut health care providers some slack during the COVID-19 emergency, partly because providers had to quickly navigate dozens of new regulatory flexibilities, including ones related to telehealth and telemedicine. For the most part, enforcement teams are running at full speed again, which makes compliance a priority for all health care organizations in 2021.
With all the attention placed on home-based care, home health operators especially must be on their toes.
“On the one hand, the Biden administration is talking about increasing funding for home health care, which is a huge positive for the industry,” Roark said. “But I think they intend to couple that with continuing to vigorously pursue fraud enforcement where they think that is appropriate and necessary.”
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