Healthcare Compliance Perspective:
Medicare Fraud and Abuse is serious problem that can cost taxpayers billion of dollars, but also puts beneficiaries health and welfare at risk. In the example below, policies and procedures not upheld, documents were falsified, identified violations were not corrected, verification systems were circumvented, and proper employment procedures were not followed.
A home family care facility and its president will pay $6.415 million to resolve allegations that it violated the federal and New York False Claims Acts by falsely billing the New York State Medicaid program for home health care services that were not provided or that were provided by unqualified staff. In a separate agreement, the former vice president has agreed to pay $100,000 to resolve the allegations against him.
The settlement resolves allegations that the healthcare facility routinely permitted its aides to circumvent verification procedures supposedly put in place by the facility to ensure that its aides were providing scheduled services to Medicaid recipients who depended upon them. The electronic attendance verification system required aides to call a central number to “clock in” and “clock out” of their shifts before their services could be billed; however, aides routinely ignored this requirement and failed to clock in or out of their shifts but were still paid for them.
The aides’ supervisors (referred to as ‘Coordinators’), allegedly modified or created call entries in the attendance verification system to make the records appear that the aides had clocked in or out of their shifts. The complaint alleged that the healthcare provider billed for these services, without even attempting to contact the aides or otherwise verify that the aides had visited their clients. Further alleged in the complaint, a former vice president of the facility who supervised the Coordinators, was aware of the efforts of the aides and Coordinators to circumvent the attendance verification systems and took no measures to stop it.
The facility’s is alleged to have employed many individuals who were not qualified to provide home health care services, and who used false identities stolen from qualified individuals to obtain employment. Even after becoming aware that unqualified individuals were obtaining employment using false identities no one at the facility took any meaningful steps to ensure that provider’s clients were being properly cared for by qualified aides.
The investigation was triggered by a whistleblower lawsuit filed under the qui tam provisions of the federal and New York False Claims Acts.
