Consumer Fraud

Iowa home health care company pays $5.63 million to resolve False Claims Act allegations

whistleblower Iowa home health care company pays $5.63 million to resolve False Claims Act allegationsAn Iowa home healthcare company has agreed to pay the U.S. and the state of Iowa $5.63 million to settle False Claims Act allegations that it submitted false claims for home health care to Medicare and Medicaid.

The U.S. Justice Department alleged that ResCare Iowa, a subsidiary of Louisville, Ky., based ResCare Inc., violated Medicare and Medicaid rules mandating that an independent physician certify the need for a patient’s home health care services. The physician must also determine the type and amount of home health care services the patient needs.

According to the complaint, ResCare billed the government from 2009 to 2014 for services provided to Medicare and Medicaid beneficiaries without documenting its compliance with this requirement. The complaint also alleged that that the company failed to comply with a rule enacted in 2011 requiring physicians to perform an in-person, face-to-face assessment of the patient and his or her home care needs.

Because ResCare failed to observe these key rules, its billing of Medicare and Medicaid amounted to a submission of false claims, the complaint alleged.

The state of Iowa will receive $2.32 million of the settlement amount for its Medicaid program. Medicaid is jointly funded by the states and the federal government. The remaining $3.31 million will go back to the federally funded Medicare program.

U.S. Attorney Kevin W. Techau of the Northern District of Iowa said the office “commenced this investigation due to concerns that this provider was not complying with the rules and was not submitting accurate claims for payment.

“When the government pays for home-based medical services, we are dedicated to ensuring the money is well spent and medically deserving patients receive the care to which they are entitled.”

The False Claims Act is one of the government’s most powerful tools in the effort to combat Medicare and Medicaid fraud. Since 2009, the U.S. government has reclaimed nearly $24 billion through False Claims Act cases, most of which originate with whistleblower witnesses who are entitled under the Act to sue on behalf of the federal government and share a percent of the recovery.

Other recoveries, such as this one, are the result of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative – a partnership between the U.S. Justice Department and the Health and Human Services Department that investigates and prosecutes suspected cases of health care fraud.

Source: U.S. Department of Justice