Over the last few years, many Americans have decided against putting elderly family members in assisted living facilities or nursing homes, citing rising costs and a desire to allow their loved ones to live out their last years at home as the reasons. This shift has resulted in in-home care becoming one of the fastest-growing sectors in health care. Coincidentally, home health care fraud is fast becoming a common and serious issue that deserves attention.
MD2U Home Health Care Fraud ‘Extreme,’ According to DOJ
This week, the home health care firm MD2U added itself to the growing list of bad actors in the home health care industry. The Justice Department announced on Thursday that the Louisville, Kentucky-based company agreed to pay an estimated $21.5 million to resolve fraudulent billing practices that were so widespread, the government referred to MD2U as an “extreme outlier.”
According to government claims, MD2U violated the False Claims Act by knowingly submitting false bills for home health care to Medicare and other government health care agencies. Specifically, the government accused MD2U of altering records to support their fraudulent claims as well as providing services that were medically unnecessary.
The government complaint states that between July 1, 2007, and November 30, 2014, MD2U submitted fraudulent bills based on care for patients who were neither homebound, not home-limited, billed government health care agencies for care considered to be medically unnecessary, manipulated medical records in order to justify patient visits and billed for services using the highest possible payment codes when lower codes were more appropriate (this tactic is often referred to as ‘upcoding’).
Here are just a few examples of how the MD2U home health care fraud scheme worked:
- MD2U would require non-physician providers (known as NPPs) to document that certain patients were homebound or home-limited, as well as indicate in medical records that outpatient visits could jeopardize patient health, regardless of whether or not either claim was true.
- MD2U management urged NPPs to visit patients more frequently than medically necessary in order to increase billings. The company also required NPPs to perform medically unnecessary visits in order to submit false billings.
- A review of MD2U billings showed that between July 1, 2007, and November 30, 2014, roughly 98 percent of all Medicare claims were false.
- NPP patient visits would for as little as 34 seconds (as demonstrated in at least one reviewed case). Often, these visits lasted less than 10 minutes. The visits were nonetheless billed as comprehensive medical visits billed at the highest possible code. Based on the code submitted, practitioners should have been spending about 60 minutes with each patient.
- NPPs were trained to bill all encounters at the highest possible code.
- MD2U used an electronic medical records system, which allowed NPPs to cut, copy, and paste patient medical notes from prior visits. This ability to manipulate patient records created the illusion that NPPs were performing significant work on patients when, according to the Justice Department, they were not.
- In the event that a patient’s medical documentation wasn’t sufficient enough for MD2U to bill at the highest possible code, NPPs were instructed to go back into the patient’s records and falsely claim that more work had been performed during a visit in order to justify billing at the highest code.
Details of MD2U Home Health Care Fraud Settlement
The defendants have admitted to violating the False Claims Act by making or causing others to make false statements, and submitting or causing others to submit false claims to the U.S. government. These actions caused damages and MD2U is liable to the U.S. in the amount of $21,511,756.
Defendants J. Michael Benfield (CEO and President of MD2U), Greg Latta (CIO), and Karen Latta (COO), all owners, admit that due in part to the actions of a former MD2U employee, they caused false claims to be submitted to the government. As such, the defendants will pay $3.3 million and a percentage of MD2U’s net income for a term of five years. Additionally, the defendants agreed to enter into a corporate integrity agreement with the Department of Health and Human Services’ Office of Inspector General for a period of five years.
Preventing Home Health Care Fraud
The Bureau of Labor Statistics (BLS) projects that between 2012 and 2022, demand for home health care aides will increase by a whopping 48 percent. With this boom in the industry, it is all but inevitable that some companies will attempt to bilk money from the government via home health care fraud.
But home health care fraud is preventable if men and women in the industry report wrongdoing when they see it. If you have information concerning a home health care fraud scheme, consider reaching out to a whistleblower lawyer. An experienced whistleblower lawyer can help you better understand your rights and guide you through your options.