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U.S. ex rel. Brown v. Amedisys, Inc. – Why Medicare Fraud is Not a Victimless Crime

Recently, the U.S. Justice Department announced that one of the largest home health care providers in the country, Amedisys Inc., agreed to settle a whistleblower lawsuit for $150 million, following allegations that they improperly billed Medicare.
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According to documents in U.S. ex rel. Brown v. Amedisys, Inc., the first of seven lawsuits filed throughout the country against the firm, the agency charged the government for services that either weren’t performed or weren’t necessary.

Fort Lauderdale nursing home abuse attorneys recognize this is a situation where negligence and fraud may intersect. It goes beyond making patients appear sicker than they were on government forms (which is part of what was alleged by the nurse whistleblowers).

When nursing home or elderly home health care patients undergo treatments, surgeries or medication routines they do not need, there is the possibility they could suffer serious harm.

In some cases of Medicaid fraud, providers have been caught charging the government for care that was necessary, but never provided. Here again, the possibility for harm is great.

Amedisys, Inc. operates in 37 states (with 28 locations in Florida), as well as D.C. and Puerto Rico.

The lawsuits allege that from 2008 to 2010, a number of the agency’s offices improperly billed the government for ineligible patients and services. For example, the agency is accused of billing for nursing and therapy services that weren’t medically necessary. In some cases, these services were provided to patients who weren’t homebound, though it was misrepresented to the government that they were.

The government alleged that the wrongful billing was not the result of innocent error, but rather pressure placed by management on therapists and nurses to provide care on the basis of the company’s bottom line, rather than true patient needs.

There was also evidence that the company was getting kickbacks from certain doctors to whom the unnecessary procedures and treatment were being referred. The federal Anti-Kickback Statute bars financial relationships between home health care providers and doctors to whom patients are referred.

One of those cases involved an oncology practice in Georgia where cancer treatments were being offered at below-market rate. Not only did this violate statutory requirements, but there is evidence that some of those cancer treatments may not have been necessary.

We can unfortunately expect to see more cases like this in the future. The FBI reports that the economic cost of health care fraud is between 3 to 10 percent of all healthcare spending, which works out to roughly $68 billion to $260 billion every year.

Beyond raising overall health care costs, patients – including those in nursing homes receiving home health care – may suffer directly as a result of companies making profits the No. 1 priority.

Under the settlement agreement, Amedisys won’t admit liability or wrongdoing for these actions. Largely, this is done to shield the firm from future litigation. However, even absent an admission of guilt from a nursing care provider, it’s possible a case for liability could made in civil court, particularly where it can be shown that a patient was harmed due to receipt of treatments that weren’t necessary.

Call Freeman Injury Law — 1-800-561-7777 for a free appointment to discuss your rights.

Additional Resources:
Amedisys home health companies agree to pay u.S. $150 million to resolve false claims act allegations, April 23, 2014, U.S. Attorney’s Office for the Eastern District of Pennsylvania

More Blog Entries:
Florida Senate Passes Bill Shielding Nursing Home Industry Interests, April 22, 2014, Fort Lauderdale Nursing Home Negligence Lawyer Blog

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