October 20, 2022. The United States Department of Justice settled two qui tam lawsuits against home healthcare provider Carter Healthcare for billing Medicare for unnecessary medical procedures and for a Medicare and TRICARE unlawful referral scheme. In U.S. ex rel. Duffield et al. v. CHC Holdings, LLC et al., Case No. 17-CV-826-HE (W.D. Okla.), Carter Healthcare will pay $22.9 million to resolve allegations that it paid medical directors in Oklahoma and Texas for referrals of Medicare and TRICARE patients. Under the terms of the settlement in U.S. ex rel. Mahaffey and Brimer v. Carter Healthcare, Stanley Carter and Brad Carter, CV 16-80459 MARRA (S.D. Fla.), the home health provider will pay $7.175 million to resolve allegations of overbilling for medically unnecessary therapy and upcoding diagnoses in Florida, and the two whistleblowers in this case will receive $1.3 million for reporting fraud. The whistleblowers were all former employees of Carter Healthcare.
The Oklahoma scheme involved alleged misconduct taking place between 2013 and 2020, wherein the home health provider remunerated doctors with gifts to serve as “medical directors” and refer their Medicare and TRICARE patients to Carter Healthcare for their in-home medical care needs. This type of activity violates the Stark Law and Anti-Kickback Statute and taints any claims made to taxpayer-funded healthcare programs.
In Florida, the two whistleblowers were therapists who previously worked for Carter Healthcare. They alleged that from 2014 to 2016, the home health provider had a practice of billing Medicare for therapies “provided without regard to medical necessity and overbilled for therapy by upcoding patients’ diagnoses.”
Because of these schemes, the home health provider’s President and Chief Operations Officer are paying individual fines, being excluded from Federal healthcare programs for five years, and entering into a Corporate Integrity Agreement with the Department of Health and Human Services – Office of the Inspector General (HHS-OIG). As the Acting Special Agent in Charge for HHS-OIG commented about the Oklahoma case, “The taxpayer dollars that fund Medicare and Medicaid are meant to support the delivery of health care services most suitable for beneficiaries. The payment of kickbacks to medical providers to induce referrals for home health services can improperly divert those dollars and undermine the quality of care being provided to patients.”
Physicians and healthcare companies that engage in kickback schemes harm the public’s perception of the medical profession and siphon taxpayer dollars away from medically necessary treatments for patients in need of them. People with inside knowledge of these fraud schemes, such as the whistleblowers in these cases, are encouraged to come forward and speak up when they believe their employer is potentially violating the law. The False Claims Act includes provisions for protecting whistleblowers from retaliation, and whistleblowers may receive 15-25% of the government’s recovery in a qui tam case.
If you would like to report home healthcare fraud, you can contact attorneys at Tycko & Zavareei LLP. Eva Gunasekera and Renée Brooker are former officials of the United States Department of Justice and prosecuted whistleblower cases under the False Claims Act. Eva was the Senior Counsel for Health Care Fraud. Renée served as Assistant Director at the United States Department of Justice, the office that supervises False Claims Act cases in all 94 United States District Courts. Eva and Renée now represent whistleblowers. For a free consultation, you can contact Eva Gunasekera at [email protected] or contact Renée at [email protected] (tel.: 202-417-3664). Visit Tycko & Zavareei LLP’s website for whistleblowers to learn more at https://www.fraudfighters.net/.