The Department of Justice announced a False Claims Act settlement where Amedisys agreed to pay $150 million and will be bound by a Corporate Integrity Agreement as a result of alleged improper financial relationships and false billing. The settlement resolves seven qui tam (whistleblower) lawsuits brought primarily from former Amedisys employees. The whistleblowers will collectively split over $26 million from the settlement. Among the claims alleged were that Amedisys billed Medicare for services to ineligible patients by misrepresenting patients’ conditions to increase its Medicare billings as well as maintaining improper relationships with referring physicians. This settlement is an achievement for HEAT, the Health Care Fraud Prevention and Enforcement Action Team initiative announced in 2009, which continues to combat health care fraud having recovered more than $19.2 billion through False Claims Act cases, with more than $13.6 billion recovered in cases involving fraud against federal health care programs.
A copy of the Department of Justice press release is available at: http://www.justice.gov/opa/pr/2014/April/14-civ-422.html.
False Claims Act, Stark, and Anti-Kickback laws are serious regulations, and health care providers need to be aware of the risks involved.
By Denise Bloch