Home Health Care Agency Pays $25 Million to Settle Fraud Allegations A home health care agency agreed to pay $25 million to the United States, the state of Tennessee and a whistleblower to resolve allegations of Medicare and Medicaid fraud (United States ex rel. Gonzales v. J. W. Carell Enterprises, Inc., et al.). The complaint alleges that Nashville-based CareAll Management LLC, ... News in Brief
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News in Brief  |   January 01, 2015
Home Health Care Agency Pays $25 Million to Settle Fraud Allegations
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Practice Management / Regulatory, Legislative & Advocacy / News in Brief
News in Brief   |   January 01, 2015
Home Health Care Agency Pays $25 Million to Settle Fraud Allegations
The ASHA Leader, January 2015, Vol. 20, 12. doi:10.1044/leader.NIB3.20012015.11
The ASHA Leader, January 2015, Vol. 20, 12. doi:10.1044/leader.NIB3.20012015.11
A home health care agency agreed to pay $25 million to the United States, the state of Tennessee and a whistleblower to resolve allegations of Medicare and Medicaid fraud (United States ex rel. Gonzales v. J. W. Carell Enterprises, Inc., et al.).
The complaint alleges that Nashville-based CareAll Management LLC, one of Tennessee’s biggest home health providers, violated the False Claims Act by overstating the severity of patients’ conditions to increase billings and by billing for services that were not medically necessary and rendered to patients who were not homebound.
The lawsuit was filed in April 2012 in the Middle District of Tennessee under the federal False Claims Act and was amended to include allegations related to the Tennessee Medicaid False Claims Act. Both acts allow private citizens to sue on behalf of the federal and state governments when they believe an individual or company has submitted false claims for government funds. Toney Gonzales, a registered nurse who was the director of services for CareAll’s Knoxville office, initiated the suit.
This settlement was CareAll’s second settlement of alleged False Claims Act violations in the two years—it paid nearly $9.38 million in 2012 for allegedly submitting false cost reports to Medicare.
As part of the settlement, the company agreed to terms of an enhanced and extended corporate integrity agreement with the Department of Health and Human Services-Office of Inspector General to avoid future fraud and compliance failures.
Since January 2009, the Justice Department has recovered more than $23.1 billion through False Claims Act cases. More than $14.8 billion of that amount was recovered in cases involving fraud against federal health care programs.
The claims resolved by the settlement are allegations only and there has been no determination of liability.
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January 2015
Volume 20, Issue 1