The United States Department of Justice and several whistleblowers reached an agreement with home healthcare provider Amedisys, Inc. to resolve civil fraud liabilities under the Federal False Claims Act (“FCA”) for $150 million. In addition to paying a $150 million civil settlement, Amedisys will be bound by a Corporate Integrity Agreement (CIA) with the Office of Inspector General of the United States Department of Health and Human Services (OIG-HHS). This settlement concludes multiple whistleblower suits, including one brought by CAF Partners, represented by Suzanne Durrell of Durrell Law Office and Robert M. Thomas, Jr. of Thomas and Associates, affiliates of the Whistleblower Law Collaborative, and Tavy Deming and Emily Lambert of Kenney & McCafferty. This settlement marks the successful conclusion of a nearly six-year effort by CAF Partners to expose fraudulent practices by Amedisys. While the case was filed in 2010, in fact, actions by one of the partners date back to September 2008 when, voluntarily, and out of a sense of duty, the individual placed a call to a regional office of the OIG-HHS. On that call, and over the course of a year of follow-up discussions with the government, the individual presented well-founded allegations regarding a systematic manipulation of data by Amedisys to make patients appear sicker than they actually were in order to justify extra, unnecessary therapy visits to qualify for bonus payments under the Medicare Home Health Prospective Payment System. In addition, Amedisys sought not only to admit, and subsequently recertify, patients to home health care that did not meet the Medicare guidelines for services, but also targeted patients for recertification in order to qualify for higher reimbursement from Medicare. Tavy Deming of Kenney & McCafferty says, “Amedisys continued to pad its soaring Medicare profits by revamping its menu of therapy programs to hit revised Medicare therapy bonus thresholds that to took effect in 2008.” In that year, diagnoses for which Amedisys previously provided 10 or 11 therapy visits suddenly required an increased number of visits that tracked the revised Medicare therapy bonus thresholds of 6, 14, and 20. “Our client had a tremendous amount of evidence … and is extremely pleased with the knowledge that its information contributed to the curbing of practices utilized to drive corporate profits,” said Emily Lambert of Kenney & McCafferty.
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