ATLANTA, Ga. (CW44 News At 10) – PruittHealth, Inc. and affiliated entities (“Pruitt”) have agreed to pay $ 4.2 million to resolve allegations they submitted claims for home health services that were not covered by Medicare and Medicaid programs, and that they did not reimburse the overpayments they had received from Medicare and Medicaid in a timely manner.
“The Medicare and Medicaid programs depend on providers to submit only claims eligible for reimbursement and to promptly notify programs if they receive payments to which they are not entitled,” said US Attorney Kurt R. Erskine. “Health care providers should not put their own financial well-being ahead of their Medicare and Medicaid homework. “
READ MORE: Investigation after the death of an inmate
“When healthcare entities seek to increase their profits through improper billing, they undermine the trust taxpayers have in the healthcare industry,” said Special Agent in Charge Derrick L. Jackson. “This settlement demonstrates the commitment of our agency and its law enforcement partners to prosecute those who seek to enrich themselves unduly at the expense of federal health care programs.”
“When funds from programs like Medicare and Medicaid are not used as intended, taxpayers and those entitled to those funds suffer,” said Chris Hacker, special agent in charge of the FBI Atlanta. “These regulations are the result of the FBI’s commitment to work with our federal and state partners to ensure that federally funded health care programs are not abused by providers.”
Home health services consist of skilled care provided to homebound recipients for the treatment of acute illnesses and injuries. Following widespread fraud in the submission of home care claims, Medicare and Medicaid began requiring referring physicians to certify in writing, after a face-to-face visit with the recipient, that the beneficiary was homebound and in need of skilled care. Medicare and Medicaid also require the doctor to develop and sign a care plan for the recipient.
The government alleges that from January 1, 2011 to June 30, 2012, Pruitt knowingly submitted claims to Medicare and Medicaid for home health services that were not eligible for reimbursement because, among other things, they did not. face-to-face contacts required. certifications or care plans, and they did not document the recipient’s homebound status or need for home health services. The government further alleges that Pruitt learned that he had received payments for home health care services to which he was not entitled, but that he did not disclose his receipt of the overpayments, nor reimbursed them. timely Medicare and Medicaid overpayments.
READ MORE: Kendra Scott Partners With Tampa General Hospital To Raise Money For TGH Children’s Hospital
In reaching a settlement with Pruitt, the government took into account documents produced by Pruitt indicating that Pruitt subsequently took steps to improve its compliance with the home health requirements of the Medicare and Medicaid programs, including recruitment. an external consultant in January 2013 to conduct an audit of its home health claims, the implementation of a pre-bill review of home health claims between February 2013 and August 2013, and the implementation of quarterly audits of its home health claims (with more frequent audits as needed) from September 2013 through the present. Pruitt voluntarily presented the results of his 2013 audit to the government during the investigation. Although the government has taken these measures into consideration, this is not an indication or concession as to the sufficiency of these compliance measures.
This settlement resolves a lawsuit originally filed in the United States District Court for the Northern District of Georgia by Tina Peery (the Relator) under the qui tam or the whistleblower provisions of the False Claims Act: United States ex rel. Tina Peery v. UHS-Pruitt Holdings, Inc., et al., No.1: 14-cv-01016-AT. Under the False Claims Act, private citizens can sue for misrepresentation on behalf of the United States and participate in any collection obtained by the government. The Relator will receive over $ 700,000.00 of the regulations.
The claims resolved by the settlement are only allegations, and there has been no determination of liability.
This case was investigated by the United States Attorney’s Office for the Northern District of Georgia, the Office of the Inspector General of the United States Department of Health and Human Services, the Federal Bureau of Investigation. and the Georgia Medicaid Fraud Control Unit.
NO MORE NEWS: Woman arrested for drunk driving and manslaughter after vacation man dies in I-4 crash
The civil settlement was reached by Deputy U.S. Attorneys Neeli Ben-David and Anthony DeCinque, as well as Deputy Attorney General of Georgia, Sara Vann.