Amedisys, Inc. and some of its affiliated entities (collectively “Amedisys”) have agreed to settle allegations made by whistleblowers in seven separate qui tam lawsuits that the companies violated the False Claims Act, the Anti-Kickback Statute, and the Stark Law. According to the Justice Department, Amedisys has agreed to pay $150 million to settle all of the allegations.
According to its website, Amedisys is one of the nation’s largest providers of home health and hospice care. Amedisys is headquartered in Baton Rouge, Louisiana and does business in 37 states, the District of Columbia, and Puerto Rico.
According to the Justice Department, between 2010 and 2013, seven whistleblower lawsuits were filed under the qui tam provision of the False Claims Act in federal court in Pennsylvania and Georgia against Amedisys. The whistleblowers in those cases alleged that Amedisys employees submitted false claims to government healthcare programs, such as Medicare, and maintained improper financial relationships with referring physicians. Specifically, it was alleged that between 2008 and 2010, Amedisys misrepresented the conditions of its patients in order to increase its Medicare billing and billed Medicare for services that were not medically necessary or were provided to patients who were not home bound.
In addition, the complaint in the Georgia qui tam case alleged that Amedisys had an improper financial relationship with a private oncology practice in violation of the Anti-Kickback Statute and the Stark Law. The Stark Law restricts certain physician referrals. Specifically, it prohibits physician referrals of designated health services, such as home healthcare, for Medicare patients if the physician has a financial relationship with the entity he or she is referring patients to.
Amedisys agreed to pay the government $150 million to resolve the whistleblowers’ allegations. In addition, it agreed to be bound by the provisions of a Corporate Integrity Agreement with the Department of Health and Human Services-Office of Inspector General. The whistleblowers, most of whom are former Amedisys employees, will share in $26 million of the settlement proceeds as their collective reward under the qui tam provision of the False Claims Act.
If you have personal knowledge of potential healthcare fraud, click here to see if you may have a viable qui tam case.