Health Care Company Agrees to Settle Civil Fraud Charges for $12.5 Million
Loretta E. Lynch, United States Attorney for the Eastern District of New York, and Special Agent-in-Charge Tom O’Donnell of the Office of the Inspector General for the Department of Health and Human Services (HHS), Region II, announced that Gentiva Health Services, Inc., of Atlanta, Georgia, and formerly of Melville, New York, has paid $12.5 million to settle allegations that it fraudulently billed Medicare for costs not covered by the program.
Gentiva is one of the largest providers of home health care services in the world, with over 200 home health agencies in the United States. Through these agencies, Gentiva provides skilled nursing and home health aide services to patients, many of whom are Medicare beneficiaries.
A home health care provider may only bill Medicare for reasonable costs that are related to patient care. Although Medicare does cover certain advertising costs, it does not pay for the cost of advertising to the general public which seeks to increase patient utilization. An investigation established that, through its annual submission of cost reports to Medicare for the years 1998 through 2000, Gentiva improperly billed Medicare for salaries and other costs of employees performing sales functions that were designed to increase patient utilization. Gentiva has denied the government’s allegations.
“Home health agencies that improperly bill Medicare for costs that cannot be lawfully reimbursed will be held accountable for their fraud,” stated United States Attorney Lynch. “This settlement reflects the ongoing commitment of this Office to root out fraud on the Medicare Program.”
“Investigating health care fraud is a priority of this office,” stated HHS Special Agent-in-Charge O’Donnell. “Those who attempt to do so will pay the price.”
The government’s case was litigated by Assistant United States Attorney Richard K. Hayes with audit assistance from Emily J. Rosenthal, Affirmative Civil Enforcement Auditor, and investigated with the assistance of the Office of the Inspector General of the Department of Health and Human Services.
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