April 24, 2014

Feds: home health company paying $150M settlement

Amedisys Inc., a Baton Rouge-based home health company with operations in Whitfield and Murray counties, will pay $150 million to resolve allegations that it inflated Medicare billings and had improper financial relationships with referring physicians, the U.S. Department of Justice said this week.

Amedisys and its affiliates make up one of the nation’s largest home health providers, operating in 37 states, Washington, D.C., and Puerto Rico, according to a Justice Department news release.

According to the company’s website, it operates Amedisys Hospice of Dalton and North Georgia Home Health Agency in Dalton and Chatsworth. Officials at those local locations referred questions to corporate headquarters Thursday afternoon.

“We are pleased to put this matter behind us,” Ronald A. LaBorde, president and interim chief executive officer for Amedisys, said in a statement. “Our organization fully cooperated with the investigation, although we disputed the allegations of misconduct and accepted no wrongdoing. Our focus continues to be on providing the highest quality of care to the 360,000 patients served by our dedicated caregivers each year, while delivering value to our shareholders.”

The settlement does not admit guilt, prosecutors noted.

The agreement resolves False Claims Act allegations that, between 2008 and 2010, some Amedisys offices billed Medicare for unnecessary services and for patients who were not homebound, and misrepresented patients’ conditions to increase its Medicare payments.

“These billing violations were the alleged result of management pressure on nurses and therapists to provide care based on the financial benefits to Amedisys, rather than the needs of patients,” according to the Justice Department news release.

In its own press release, Amedisys said it disputed the government’s allegations of misconduct and “decided to settle to avoid the cost and uncertainty inherent in protracted litigation.”

“The (government) investigation primarily centered on determinations made by Amedisys clinicians and independent physicians that patients were homebound and needed skilled nursing or therapy services, and that the services provided were medically necessary,” said the company’s press release. “Each year, Amedisys’ dedicated clinicians provide care to more than 360,000 patients, many of whom suffer from more than one chronic and debilitating disease.”

The settlement also resolves seven whistleblower lawsuits, six in Pennsylvania and one in Georgia. The whistleblowers, mostly former Amedisys workers, will split more than $26 million.

Prosecutors also alleged that Amedisys workers coordinated patient care at below-market prices for a private cancer practice in Georgia that referred patients to the company.

Amedisys’ financial relationship with a private oncology practice in Georgia — whereby Amedisys employees provided patient care coordination services to the oncology practice at below-market prices — violated statutory requirements.

“Home health services are a large and growing part of our federal health care system,” said Sally Quillian Yates, U.S. attorney for the Northern District of Georgia. “Health care dollars must be reserved to pay for services needed by patients, not to enrich providers who are bilking the system.”

Federal prosecutors in Alabama, Kentucky, South Carolina and New York State also worked on the case.

Company officials also signed an agreement with the Department of Health and Human Services’ office of inspector general, requiring the company and its affiliates to set up measures designed to avoid or promptly detect conduct similar to that which gave rise to the settlement.


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