United States ex rel. CAF Partners v. Amedisys, et al., Civ. No.:10-cv-02323 (E.D. PA)
Jan 01, 2010OUTCOME:
This whistleblower case was filed against Louisiana based home healthcare provider Amedisys, Inc. (“Amedisys”) to resolve civil fraud liabilities under the Federal False Claims Act (“FCA”) for $150 mil ... lion. 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, announced in April 2014, is by far the largest home healthcare settlement in the history of the FCA. This settlement marked the successful conclusion of a nearly six year effort by CAF Partners to expose fraudulent practices by home health behemoth 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 articulated 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 (“PPS”). The members of CAF Partners who joined with this individual also brought unique and valuable insight into the use, and impact, of Amedisys’s proprietary software system. Through this system, CAF Partners alleged that 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. Kenney & McCafferty were co-counsel in this case. Learn more about this case at the Whistleblower Collaborative sebsite at www.ThomasDurrell.com
