Home Healthcare And Hospice Provider Settles For $3.85 Million Over Alleged Medicare Fraud

Intrepid U.S.A., Inc. and its subsidiaries have agreed to a $3.85 million payout to settle claims they fraudulently billed Medicare, the U.S. Department of Justice announced. It was alleged that the company abused two critical service lines—home healthcare and hospice care—by billing Medicare for ineligible patients or non-qualified services between 2016 and 2021. The accusations indicated that these facilities took advantage of programs meant to serve our most vulnerable, effectively prioritizing profit over patient care.

While the skeletons of these accusations rattled loudly in the closets of 19 Intrepid home healthcare facilities and three hospice facilities, it was a couple of company insiders acting as whistleblowers who brought these issues to light. According to the Justice Department announcement, some patients were admitted to hospice care without being terminally ill, while others should have been discharged because they didn't meet the care requirements. In the home healthcare instances, some patients did not qualify for the services they received, which were sometimes delivered by untrained staff or, worse, not at all.

"Medicare's hospice and home healthcare benefits provide critical services to vulnerable patient populations across the country," said Principal Deputy Assistant Attorney General Brian M. Boynton, as stated by the U.S. Attorney's Office, District of Minnesota. Ensuring compliance with these benefits "not just to enrich those who seek to provide them" remains a commitment of the department. As Intrepid agrees to the multi-million dollar settlement, shame hangs over the company for submitting knowingly, claims for services that patients didn't need or weren't entitled to receive, thus violating the trust of those reliant on Medicare's assurance.

In echoing the sentiments of law enforcement partners, Tamala E. Miles, Special Agent in Charge of the Department of Health and Human Services Office of Inspector General (HHS-OIG), remarked at the press that "Exploiting these systems for financial gain is intolerable." The collaborative efforts to pursue providers prioritizing monetary gain over quality patient care are reinforcing the integrity of healthcare services. This settlement further showcases the powers combined of the Justice Department's Civil Division, the U.S. Attorney’s Offices for the Western District of Kentucky, and the District of Minnesota, in addition to HHS-OIG's relentless investigative work.

As part of the settlement, whistleblowers Jennifer Jones, a former travel nurse, and Pamela Joffe, a former Director of Quality Assessment Performance Improvement and New Business Development at Intrepid, will receive $333,985, as per the U.S. Attorney's Office, District of Minnesota. Conversely, Marsha Rigney, former Director of Clinical Excellence and Integrity, and Janet Watts, a former Regional Manager of Clinical Excellence at Intrepid, will take home $359,014. These payments are provided under the whistleblower provisions of the False Claims Act—a federal law that allows private parties to sue on behalf of the government for false claims and to share in any recovered funds.

SOURCE: hoodline