A Tennessee home healthcare company was forced to pay $25 million to settle its second fraud case in two years.
CareAll, a collection of home nursing and rehabilitation companies, defrauded both Medicare and Medicaid by billing inflated and falsified costs to the federal programs for home healthcare services, the Department of Justice said.
From 2006 to 2013, CareAll exaggerated the severity of patient illnesses to pad its billings and sought reimbursements for medically unnecessary services that were administered to patients who weren’t even homebound, according to the Justice Department.
But this wasn’t the home healthcare group’s first encounter with the court.
In 2012, seven CareAll companies paid nearly $9.38 million collectively for allegedly hiding their relationship to the company managing them on Medicare billings submitted between 1999 and 2001.
CareAll Management, LLC would have received smaller Medicare reimbursements if the government had known the seven companies were submitting bills and operating under its direct control, the Justice Department alleged.
DOJ officials said James W. Carell, the owner of CareAll Management, executed the “sham” by enlisting a friend to buy the seven smaller home healthcare companies and secretly paying him to hold them in his name while Carell maintained control behind the scenes.
Following the 2012 settlement, CareAll agreed to sign a Corporate Integrity Agreement with the Health and Human Services Department’s inspector general. The agreement was supposed to have lasted five years.
HHS negotiates these agreements with healthcare providers as part of the settlements that arise from fraud investigations. Providers agree to a set of obligations, such as submitting annual reports to the IG and hiring a staff member to oversee compliance with the law, and in exchange, HHS agrees not to ban the provider from participating in Medicare, Medicaid and other government healthcare programs.
CareAll was forced to sign another Corporate Integrity Agreement after the latest round of fraud litigation.This agreement, if followed, would take the embattled healthcare group into 2019.
The most recent fraudulent billing scheme came to light after a whistleblower alerted the government to CareAll’s actions under the False Claims Act. Because the act allows whistleblowers to share in government recoveries, the individual will receive $3.9 million from the settlement.
Since 2009, the Health Care Fraud Prevention and Enforcement Action Team, a joint task force between the Justice Department and HHS, has recovered nearly $15 billion from federal healthcare fraud.
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