Amedisys Agrees to Pay $150M to Settle Whistleblower Claims

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Amedisys, Inc. has agreed to pay $150 million to settle a whistleblower lawsuit alleging that the national home health care company violated the False Claims Act by submitting false billings to the Medicare program. According to a press release issued by the Department of Justice on Wednesday, the company was pressuring employees to bill for services that did not provide or were unnecessary.

“It is critical that scarce Medicare home health dollars flow only to those who provide qualified services,” Stuart F. Delery, Assistant Attorney General for the Civil Division, stated in the release.  “This settlement demonstrates the department’s commitment to ensuring that home health providers, like other providers, comply with the rules and don’t misuse taxpayer dollars.”

There have been allegations that Amedisys offices improperly billed Medicare for ineligible patients and services between 2008 and 2010. Allegedly, management pressured employees to bill Medicare for medically unnecessary nursing and therapy services to patients who were not homebound and otherwise misrepresented the patients’ conditions to increase Medicare payments. These billing violations were committed in order to benefit Amedisys financially, rather than help patients. The settlement helped resolve these allegations.

The settlement also helped resolve other allegations of Amedisys’ wrongdoing. According to the release, it was alleged that the company maintained improper financial relationships with referring physicians. The United States alleged that Amedisys violated statutory requirements under the Anti-Kickback Statute and Stark Statute by providing patient care coordination services to a private oncology practice in Georgia at below-market prices.

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

The release stated that “Amedisys also agreed to be bound by the terms of a Corporate Integrity Agreement with the Department of Health and Human Services – Office of Inspector General that requires the companies to implement compliance measures designed to avoid or promptly detect conduct similar to that which gave rise to the settlement.”