United States Settles False Claims Act Allegations Against Jacksonville-Based Home Health Company For $1,293,169

Jacksonville, Florida B United States Attorney A. Lee Bentley, III announces that the United States has settled allegations that a Jacksonville-based home health company knowingly billed the government for millions of dollars of medically unnecessary services by submitting false claims to Medicare. The allegations resolved include liability under the False Claims Act (FCA).

The government has reached a settlement with Advanced Homecare, Inc. In reaching this settlement, the parties have resolved allegations that, from April 2009 until April 2012, Advanced Homecare created a set of “neurocare protocols” wherein the company accepted home health referrals from two neurologists – Dr. Sean Orr and one other provider. Through these protocols, the government alleges that Advanced Homecare accepted and treated patients who were not actually homebound and did not have a valid physician certification of home health need, as required by Medicare. Further, the government alleges that Advanced Homecare recklessly allowed its employees to aggressively market its home health services to this neurology practice and that those marketing employees gained direct access to the practice’s patient files, completed referral forms, and used the doctors’ signature stamps to sign orders, in order to circumvent the physician certification requirement. The government has agreed to accept $1,293,169 to resolve these allegations.

“The U.S. Attorney’s Office is committed to using every tool at our disposal to prevent, deter, and prosecute health care fraud,” stated U.S. Attorney Bentley. “We will continue to bring FCA cases such as this to safeguard our taxpayer resources and to ensure the integrity of our essential federal health care programs.”

This lawsuit was originally filed under the qui tam or whistleblower provisions of the False Claims Act by Marsha Yandell, a former employee at Advanced Homecare. Under those provisions, a private party, known as a relator, can file an action on behalf of the United States and receive a portion of the recovery. The relator will receive more than $200,000 as part of today’s settlement.

“Sticking taxpayers with a bill for unnecessary health care services will never be tolerated,” said Special Agent in Charge Shimon R. Richmond of the U.S. Health and Human Services, Office of the Inspector General.  “Working in close coordination with our law enforcement partners, we will tirelessly pursue health care companies that threaten the integrity of Federal health care programs.” 

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered more than $24 billion through False Claims Act cases, with more than $15.3 billion of that amount recovered in cases involving fraud against federal health care programs.

This case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General and Assistant United States Attorneys Collette Cunningham and Jason Mehta.

The claims resolved by this settlement are allegations only, and there has been no determination of liability.