CareAll Management LLC agreed to pay $25 million to the United States and the state of Tennessee to resolve allegations that it violated the False Claims Act by submitting false and upcoded home healthcare billings to the Medicare and Medicaid programs, the DOJ said Wednesday.
Nashville-based CareAll is one of Tennessee’s biggest home health providers.
This settlement resolves allegations that between 2006 and 2013, CareAll overstated the severity of patients’ conditions to increase billings and billed for services that were not medically necessary and rendered to patients who were not homebound.
Under the False Claims Act, private citizens, known as relators, can sue on behalf of the United States and share in any recovery. The DOJ can join the cases as a plaintiff.
The relator in the CareAll case, Toney Gonzales, will receive more than $3.9 million as his share of the recovery.
The DOJ didn’t provide any information about Gonzales’ or his association with CareAll.
The case was CareAll’s second settlement of alleged False Claims Act violations in the last two years.
In 2012, the company paid nearly $9.38 million for allegedly submitting false cost reports to Medicare.
As part of Wednesday’s settlement, CareAll and its affiliates agreed to comply with an enhanced and extended corporate integrity agreement with the Department of Health and Human Services-Office of Inspector General.
Since January 2009, the Justice Department has recovered more than $23.1 billion through False Claims Act cases. More than $14.8 billion of that amount was recovered in cases involving fraud against federal health care programs.
The case is United States ex rel. Gonzales v. J.W. Carell Enterprises, Inc., et al., No. 12-0389 (M.D. Tenn.).
The claims resolved by the settlement are allegations only and there has been no determination of liability, the DOJ said.
The DOJ’s November 12, 2014 release is here.
Richard L. Cassin is the publisher and editor of the FCPA Blog. He can be contacted here.