Amedisys Inc., a Baton Rouge, La.-based home health company operating in 37 states, has agreed to pay $150 million in a settlement announced last month by Joyce Vance, the U.S. Attorney for the Northern District of Alabama, and Department of Justice officials. A nurse blew the whistle on fraud at the national home health care company where she once worked.
The company made false claims for Medicare and other government health care insurance programs. U.S. Attorney Vance stated in a press release:
Amedisys made false Medicare claims, depriving the American taxpayer of millions of dollars and unlawfully enriching Amedisys. The vigorous enforcement work by assistant U.S. attorneys in my office, along with their colleagues in North Georgia, Eastern Pennsylvania, Eastern Kentucky and the Civil Division of the Justice Department, has secured the return of $150 million to the taxpayers and stands as a warning to future wrongdoers that we will aggressively pursue them.
In 2010, April Brown, a nurse in Monroeville, Ala., filed a federal lawsuit in Birmingham against Amedisys. The lawsuit alleged that the company violated the False Claims Act (FCA) by submitting false home health care billings to Medicare for home health services. Ms. Brown was a home health nurse and was seeing patients in the Monroeville area. Amedisys was asking her to bill for services she was not actually providing or that were not necessary. Nurses had to check off boxes on computerized forms during patient visits. The way the electronic forms were set up the patients were always coded for the highest level of service and the forms did not represent the patients’ true condition. They were making the patients look sicker than they really were. Ms. Brown also had patients who were not really home-bound.
Ms. Brown, who was fired after questioning the practice, was the first to file a qui tam lawsuit. Her suit and six others filed around the nation against Amedisys alleging improper billing by the company between 2008 and 2010 were consolidated in a federal court in Pennsylvania. The lawsuits were sealed from public view until last month when the settlement was announced.
The whistleblowers who filed lawsuits – primarily former Amedisys employees – will collectively split more than $26 million as fees. Ms. Brown will get $15 million of that amount. The suits by the former employees alleged the billing violations were the alleged result of management pressure on nurses and therapists to provide care based on the financial benefits to Amedisys, rather than the needs of patients.
The settlement also resolves certain allegations that Amedisys maintained improper financial relationships with referring physicians. The Anti-Kickback Statute and the Stark Statute restrict the financial relationships that home health care providers may have with doctors who refer patients to them. The United States alleged that Amedisys’ financial relationship with a private oncology practice in Georgia – whereby Amedisys employees provided patient care coordination services to the oncology practice at below-market prices – violated statutory requirements.
Jim Barger, who is with Frohsin & Barger, a Birmingham firm that specializes in whistleblower litigation, represented Ms. Brown in the most recent case. He and his firm, along with Joyce Vance and her staff, did a tremendous job in this case.