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U.S. Attorney's office settles $16 million health care fraud case Lexington, KY, home health agency and estate of deceased owner agree to judgment of $16 million to resolve allegations of health care fraud From U.S. Attorney's office U.S. Department of Justice, Eastern District of Kentucky LEXINGTON - Nurses' Registry and Home Health Corporation ("Nurses' Registry") and the Estate of its former owner, the deceased Lennie House, have agreed to the entry of a judgment against them for $16,000,000 to resolve allegations of widespread healthcare fraud. This civil judgment ends an investigation and False Claims Act litigation alleging that Nurses' Registry, at the direction of Lennie House, fraudulently billed Medicare for medically unnecessary home health services, as well as services tainted by kickbacks provided by the company and House to local physicians and others who referred patients to Nurses' Registry. "For years, Nurses' Registry abused its privileges as a provider in the Medicare program, and the trust of the medical community and general public," said United States Attorney Kerry B. Harvey. "This settlement returns ill-gotten gains to the Medicare Trust Fund and ensures that Nurses' Registry will have no further opportunity to defraud federal health care programs. Our office will continue to vigorously pursue health care fraud in this district, against companies and individuals, no matter how difficult or protracted the litigation may be." Under House's direction, Nurses' Registry engaged in systematic false billing that allowed them to wrongfully obtain millions of dollars from the Medicare program between 2004 and 2011. Medicare pays for home health services only when a physician signs a plan of care certifying that the patient is homebound and has a reasonable need for skilled nursing care or certain therapy services. To advance its health care fraud, Nurses' Registry falsified medical records to make it appear as if patients had a medical need for skilled nursing or therapy services, or appear as if the patients were homebound. At times, Nurses' Registry employees even forged physician signatures on medical records to falsely "certify" that the patient required Nurses' Registry's services. Nurses' Registry, at the direction of House, frequently re-certified patients for more and more home health services - and billed such services to Medicare - long after the patient ceased to meet Medicare's eligibility requirements. In addition to billing Medicare for unnecessary or non-reimbursable home health services, Nurses' Registry and House provided tickets to athletic events and concerts, and provided other things of value, to doctors and referral sources in order to induce or reward patient referrals. This practice was so commonplace that physicians would contact the home health agency to ask for tickets to popular events, such as Taylor Swift concerts or the Kentucky Derby. House instructed the company's marketing employees to deliver bottles of liquor and other enticements to referral sources in order to ensure more valuable patient referrals that could be billed to Medicare. These transactions violated the federal Anti-Kickback Statute as well as the Stark Law, which prohibits home health agencies from billing for services referred to them by physicians with whom they have a financial relationship. "We are focused on combatting fraud in the home health arena," said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. "Settlements like this one send a clear message that false claims to Medicare will not be tolerated." The United States filed a complaint against Nurses' Registry, Lennie House, and Vicki S. House, House's wife, in September 2011, following an investigation into a whistleblower lawsuit filed by former employees Alisia Robinson-Hill and David Price. After several years of litigation, this settlement, in conjunction with a prior settlement with Vicki House for $1,082,416, fully resolves that action in favor of the government. Under the terms of the settlement agreement, Nurses' Registry will be sold to an independent third party within 90 days, and 70 percent of the net sale proceeds will be remitted to the federal government. In addition, the Estate of Lennie House will have one year to sell off all of its assets and will turn over 75 percent of those net sale proceeds to the government. Ms. Robinson-Hill and Mr. Price will receive a share of the settlement proceeds pursuant to the qui tam provisions of the False Claims Act. The investigation conducted prior to the government filing its complaint was conducted by the Department of Health and Human Services, Office of the Inspector General; the Office of the Kentucky Attorney General, Medicaid Fraud and Abuse Control Unit ("MFCU"); the Federal Bureau of Investigation; and the U.S. Attorney's Office. The litigation was handled by Assistant United States Attorneys Christine Corndorf and Paul McCaffrey, with assistance from the Commercial Litigation Branch of the Department of Justice's Civil Division. This story was posted on 2015-10-02 06:51:19
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