United States Settles False Claims Act Cases Against Home Health Agency
Tampa, FL – The United States has settled two cases against Nurse on Call, a home health agency with locations in Sarasota and Orlando, that allege False Claims Act violations arising from having a medical director approve care for patients without having seen the patients, the alleged payment of kickbacks in the form of a sham medical director agreement, and payments to the spouses of referring physicians.
Nurse on Call allegedly paid kickbacks in the form of a sham medical directorship to a physician to refer patients to Nurse on Call. The physician allegedly did little, if any, of the work for which Nurse on Call paid him as medical director. Sham medical director agreements to induce patient referrals violate the Anti-Kickback Statute and the Stark Law. Nurse on Call also allegedly paid some employees in a manner that accounted for the volume of referrals by their physician spouses, in violation of the Stark Law. Finally, Nurse on Call allegedly requested another medical director to approve plans of care for patients whom the director never saw, in violation of Medicare regulations.
“The Anti-Kickback Statute and the Stark Law help to ensure that financial interests do not compromise the medical decision-making process,” said U.S. Attorney Maria Chapa Lopez. “Additionally, Medicare regulations requiring physicians to have face-to-face contact with patients helps to ensure that any care provided is necessary and reasonable. Our office will continue to use every tool at our disposal to combat fraud and abuse in our health care programs.”
The Anti-Kickback Statute prohibits anyone from offering or paying remuneration in order to induce or reward referrals for services paid for under federal healthcare programs. The Stark Law forbids certain medical providers, including home health agencies, from submitting claims to Medicare for services provided to patients who were referred by a physician with whom the provider has a prohibited financial relationship, unless that relationship falls within an applicable exception. Finally, Medicare regulations require home health care to be provided pursuant to a plan of care reviewed and approved by a physician who has had recent, face-to-face contact with the patient.
The lawsuits were filed under the qui tam or whistleblower provisions of the False Claims Act, which allow private parties to file suit on behalf of the United States for false claims and receive a share of any recovery. The act permits the United States to intervene in the cases and settle them, as it has done here. A defendant who violates the act is subject to three times the government’s losses, plus applicable penalties.
This case is being handled by Assistant U.S. Attorney Charles Harden of the U.S. Attorney’s Office for the Middle District of Florida, with assistance from the Federal Bureau of Investigation.
The claims made in the complaints are allegations only, and there has been no determination of liability. The cases are captioned U.S. ex rel. Spencer, et al. v. Emeritus Corp., Nurse on Call, et al., Case No. 8:13-cv-3194-T-30-TGW, and U.S. ex rel. Doe v. Nurse on Call, Case No. 8:15-cv-1043-T-17-TBM.