James W. Carell, CareAll Management LLC (formerly known as Diversifi ed He alth Mana gement Inc.), C are All Inc., the James W. Car ell Family Trust, V IP Home Nursing and Reh abilitation Servi ces L LC, Professional Home He alth Care L LC, University Home H ealth, LLC and Elizabeth Vining (as representative of the Estate of Robert Vining) have agreed to pay $9.375 million to the federal government. This payment is to resolve the lawsuit that the United States filed in 2009 alleging that they violated the False Claims Act, caused Medicare to pay out money through mistake of fact, and were unjustly enriched by falsely concealing the home health agencies’ relationship with their management company, the Justice Department announced today.
VIP, Professional and University now operate under the name CareAll. James W. Carell and the related CareAll entities named above also agreed to be bound by the terms of a Corporate Integrity Agreement with the Department of Health and Human Services – Office of Inspector General (HHS-OIG).
CareAll and its related entities are one of the largest home health providers in Tennessee. This settlement resolves the United States’ lawsuit alleging that the CareAll entities fraudulently submitted eight cost reports for fiscal years 1999, 2000 and 2001 to support their Medicare billings. The United States alleged that these cost reports were false because they knowingly hid the relationship between the management company and the home health agencies. According to the complaint the United States filed in this case, the cost reports should have disclosed that the management company was related to the home health agencies, which would have lowered the Medicare reimbursement for the management company’s services. During the relevant years, the United States alleged that James W. Carell owned the management company, and his friend Robert Vining – an attorney who lived in Missouri – served as the nominee or “sham” owner of the home health agencies.
The United States further alleged in court filings that the management company exerted significant control over the home health agencies in a myriad of ways, including: James. W. Carell’s key role in facilitating Robert Vining’s purchase of the home health agencies; loans worth millions of dollars from companies owned by James W. Carell to the home health agencies; cash transfers for millions of dollars from the management company to the home health agencies; the management company’s day to day control over the home health agencies’ operations; and Robert Vining’s role as a mere figurehead owner. The United States also alleged in court filings that James W. Carell profited greatly from this “sham” owner relationship and that he monetarily rewarded Robert Vining for his participation in this scheme.
“The false reporting scheme alleged in this case robbed the Medicare Trust Fund of millions of taxpayer dollars,” said Stuart Delery, Acting Assistant Attorney General for the Civil Division of the Department of Justice. “Settlements like this one make sure that our federal health care dollars are spent appropriately – on maintaining critical health care programs.”
“This settlement is yet another example of this office’s commitment to enforcing the False Claims Act in health care cases and protecting the taxpayer’s interests,” said Jerry E. Martin, U.S. Attorney for the Middle District of Tennessee. “The U.S. Attorney’s Office will continue to return money to the federal treasury by aggressively pursuing cases where, based on false reporting and concealment, health care companies are unjustly enriched.”
“This settlement represents a significant victory in our fight against fraud in the Medicare system,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “The OIG is committed to protecting the integrity of federal health care programs by aggressively pursuing entities that increase their revenue through deceitful schemes and trickery.”
The United States’ investigation was conducted by the U.S. Attorney’s Office for the Middle District of Tennessee, the Justice Department’s Civil Division and HHS-OIG.
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $9.3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $12.9 billion.
The case is docketed as United States v. James W. Carell, et al., No. 3:09-0445 (M.D. Tenn.). The claims settled by this a gre ement are alle gations onl y, and the re has b een no det ermination of liabilit y.