Home-Based Care Provider Liable for Millions After Admitting It Violated the Federal False Claims Act

The Department of Justice announced on July 7, 2016 that MD2U Holding Company (including its related companies and owners) a Louisville based provider of home-based health operating in eight states, entered into a consent agreement admitting that it caused the submission of false claims to the United States in violation of the False Claims Act.

Describing overbilling and unnecessary services as culprits in home healthcare fraud, U.S. Attorney John Kuhn Jr. stated:

Unfortunately, our healthcare system is under assault from a small minority of providers who engage in fraudulent billing, overbilling and providing unnecessary services. In an effort to control these losses and force accountability, my office and the Department of Justice pursues and recovers false and fraudulent billings as one of its highest priorities.  This significant case against MD2U is but one example of the vigorous work against healthcare fraud taking place in the Western District and across the nation.

The government’s complaint alleged that between July 1, 2007, and Nov. 30, 2014:

  • MD2U required non-physician providers (NPPs) to document that patients were homebound or home-limited and indicate in the medical record that an outpatient visit would jeopardize the patient’s health, regardless as to whether this was true or not. A number of MD2U patients were neither homebound nor home-limited, as some patients worked outside the home, attended school outside the home, drove independently, routinely saw other providers in the office and in at least one case, went horseback riding.
  • MD2U would require NPPs to perform medically unnecessary visits and improperly bill Government Health Care Programs for evaluation and management (E&M) visits in order to generate revenue. Management instructed NPPs to schedule patient visits more frequently than necessary in order to increase productivity.
  • NPPs’ patient visits would often last less than ten minutes with some lasting less than five minutes (and in at least one reviewed case – 34 seconds), but these encounters were billed as comprehensive medical visits and billed at the highest level E&M code possible. The American Medical Association’s guidelines for these codes indicate that practitioner’s using the codes billed by MD2U should be performing comprehensive medical exams and should typically spend 60 minutes face-to-face with the patient, family member or caregiver.
  • Management trained NPPs to bill all visits using the highest level E&M code available.
  • MD2U also utilized an electronic medical records (EMR) system that permitted the NPPs to easily electronically cut, copy and paste medical notes from prior visits. The ability to migrate notes from visits that occurred weeks, months, or even years prior to the current patient encounter created the illusion that MD2U’s NPPs were performing a significant amount of work during their patient encounters when, in fact, they were not.  If the documentation was deficient to bill the highest level code, MD2U would direct NPPs to go back and change the medical record – after the encounter had occurred – to falsely show that more work was performed during the visit in order to support the highest level billing.

Submission of false claims to the United States is a violation of the False Claims Act particularly when the submission of the claims for payment is the result of misrepresentations and/or deceptive conduct.  Ultimately these actions can result in patient harm.  Anyone with knowledge of such wrongful conduct is encouraged to contact Nolan Auerbach & White in complete confidence.