CareAll Companies Agree To Pay $25 Millionto Settle False Claims Act Allegations

CareAll Management, LLC, and its affiliated entities (collectively, “CareAll”) have agreed to pay $25 million, plus interest, to the United States and the State of Tennessee to resolve allegations that CareAll violated the False Claims Act (“FCA”) by submitting false and upcoded home healthcare billings to the Medicare and Medicaid programs, announced David Rivera, U.S. Attorney for the Middle District of Tennessee and Acting Assistant Attorney General Joyce R. Branda for the Justice Department’s Civil Division.  This is CareAll’s second FCA settlement within the last two years, having paid $9.375 million in 2012 relating to allegations of submitting false cost reports to Medicare.   The company also agreed to be bound by the terms of an enhanced and extended Corporate Integrity Agreement with the Department of Health and Human Services – Office of Inspector General (“HHS-OIG”) in an effort to avoid future fraud and compliance failures.

CareAll is based in Nashville, Tennessee and is one of Tennessee’s largest home health providers.  This settlement resolves allegations that, between 2006 and 2013, CareAll improperly billed for services that were upcoded, not medically necessary, and rendered to patients who were not homebound.  

“This case demonstrates that enforcement of the False Claims Act is a priority of the United States Attorney’s Office for the Middle District of Tennessee,” said United States Attorney David Rivera.  “The U.S. Attorney’s Office and our law enforcement partners are committed to protecting the public and vigorously pursuing all those who knowingly submit false claims affecting Medicare and Medicaid programs.”

“Home health agencies may only bill Medicare and Medicaid for care that is covered,” said Acting Assistant Attorney General Joyce R. Branda for the Justice Department’s Civil Division.  “This settlement is another example of the department’s commitment to ensuring that scarce home health care dollars are spent for their intended purposes.”

Under the FCA, private citizens, known as relators, can bring suit on behalf of the United States and share in any recovery.  The relator in this case, Toney Gonzales, will receive over $3.9 million as his share of the recovery.

“We are seeing a surge across the country in fraudulent home-based services,” said Special Agent in Charge Derrick L. Jackson of HHS-OIG in Atlanta.  “This settlement demonstrates our commitment to protect the Medicare Trust Fund and ensure that funds are not siphoned off by companies that are more concerned with the bottom line than patient care.”

The United States’ investigation was conducted by the U.S. Attorney’s Office for the Middle District of Tennessee, the Civil Division of the Department of Justice, HHS-OIG and the Tennessee Bureau of Investigation.  The United States was represented by Assistant U.S. Attorney Christopher C. Sabis and Trial Attorney Susan Lynch of the Civil Division - U.S. Department of Justice.   The case is docketed as United States ex rel. Gonzales v. J.W. Carell Enterprises, Inc., et al., No. 12-0389 (M.D. Tenn.).