Forty six senior living communities named along with individuals involved and determination of losses caused to Medicare.
In a significant crackdown on healthcare fraud, three home care agencies operating in Texas, Ohio, and Indiana have agreed to pay nearly $4.5 million to settle allegations of providing illegal kickbacks in exchange for Medicare referrals.
The U.S. Department of Justice (DOJ) announced the settlement involving Guardian Health Care Inc., Gem City Home Care LLC and Care Connection of Cincinnati LLC, home health agencies operating in Texas, Ohio and Indiana, along with their owner Evolution Health LLC (together, the Companies), have agreed to pay $4,496,330 to resolve allegations that they violated the False Claims Act by knowingly providing illegal kickbacks to assisted living facilities and physicians in exchange for Medicare referrals.
This settlement resolves allegations that, from 2013 to 2022, Guardian Health Care, Gem City Home Care and Care Connection of Cincinnati provided lease payments and other valuable benefits, including wellness health services, sports tickets and meals, to numerous assisted living facilities and their residents, as well as certain health care providers, in exchange for referrals of Medicare beneficiaries. The home health agencies then billed Medicare for the home health services they provided to the referred patients.
A kickback is a form of bribery based on receiving compensation in return for facilitating or expediting a transaction, service, or business arrangement. Kickbacks are illegal and unethical. The Anti-Kickback Statute prohibits the provision of remuneration with the intent to induce referrals of government health care program business. The Anti-Kickback Statute is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives. Claims that are knowingly submitted in violation of the Anti-Kickback Statute are ineligible for payment and can violate the False Claims Act.
Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, said in the official statement from the Office of Public Affairs:
“It is imperative to ensure that improper financial incentives play no role in decisions regarding patient care. Today’s resolution demonstrates the department’s commitment to protecting the integrity of federal health care programs and the medical treatment received by their beneficiaries.”
The Companies received credit under the department’s guidelines for taking disclosure, cooperation and remediation into account in False Claims Act cases. Among other actions, the Companies disclosed the conduct to the government, identified the individuals involved and assisted in the determination of losses caused to Medicare.
This resolution is part of a broader effort by regulators to scrutinize and address violations of the False Claims Act. In 2022, the Centers for Medicare & Medicaid Services (CMS) estimated that almost $2 billion in improper payments were authorized in violation of the act, prompting increased legal actions against non-compliant providers.
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