Best Choice Home Health Care Agency Inc. and Its Owner Agree to Pay $1.8 Million to Resolve False Claims Act Allegations That They Paid Kickbacks for Home Health Services Referrals
Best Choice Home Health Care Agency Inc. (Best Choice) and its owner, Reginald King, have agreed to pay $1.8 million to resolve allegations that Best Choice and King violated the False Claims Act by paying kickbacks for the referral of Medicaid-covered patients for home and community-based healthcare services from Best Choice. Best Choice is a home healthcare services provider based in Kansas City, Kansas. King is the owner and operator of Best Choice.
“The department will continue to hold accountable entities and individuals that engage in illegal kickback schemes for the referral of patients,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “It is critically important that we protect the integrity of government health care programs by ensuring that services are provided based on clinical considerations rather than the financial interests of those who refer patients for care.”
This settlement resolves allegations that from July 1, 2010, through Dec. 31, 2014, Best Choice submitted claims for home and community-based healthcare services to Medicaid that resulted from a kickback arrangement between King, on behalf of Best Choice and Christopher Thomas, who transported patients from their homes to healthcare facilities in Kansas City. Specifically, under this alleged arrangement, King paid Thomas $58,000 in kickbacks for new patients referred to Best Choice based on a formula which accounted for each hour of service that Best Choice billed to Medicaid.
“Fraud and abuse in Medicaid add costs without adding any value,” said Acting U.S. Attorney Tom Beall for the District of Kansas. “We fight fraud to help make health care more available and more affordable.”
The Medicaid Program is a jointly-funded federal and state program. Of the $1.8 million that King and Best Choice will pay under the settlement, the United States will receive $1,011,780 and the state of Kansas will receive $788,220.
The settlement resolves allegations originally brought under the qui tam, or whistleblower, provisions of the False Claims Act by Thomas, the recipient of the alleged kickbacks. The act permits private parties to sue on behalf of the United States for false claims for government funds and to receive a share of any recovery. The whistleblower reward in this case will be $43,178 which represents 10 percent of the federal share of the settlement, minus the amount that the relator received in kickbacks during the duration of the scheme.
The settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. 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 this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $31.6 billion through False Claims Act cases, with more than $19.2 billion of that amount recovered in cases involving fraud against federal health care programs.
This matter was handled by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the District of Kansas, the Department of Health and Human Services Office of Inspector General and the Kansas Medicaid Fraud Control Unit.
The claims resolved by this settlement are allegations only, and there has been no determination of liability. The qui tam case is docketed as United States ex rel. Thomas v. Best Choice Home Health Care Agency, Inc., and Reginald King, No. 1:13-cv-2209 (D. Kan.).