The Department of Justice announced last week that Amedisys Inc. has agreed to pay $150 million to the federal government to settle False Claims Act allegations of healthcare fraud. It is alleged that the Louisiana-based home health company submitted false home healthcare billings to the Medicare program.  Amedisys is one of the nation’s largest providers of home health services in the US, with operations in 37 states, plus the District of Columbia and the territory of Puerto Rico.

This settlement resolves healthcare whistleblower allegations that, between 2008 and 2010, Amedisys Inc. improperly billed Medicare for ineligible patients and services.  In the lawsuit, it is alleged that the company billed Medicare for nursing and therapy services that were deemed medically unnecessary, provided home health care to patients who were not actually homebound, and otherwise misrepresented their patients’ medical conditions to increase the company’s payments from Medicare.

Under the False Claims Act, it is unlawful for a company or individual to submit a false claim for payment from a government program, such as Medicare. These operations allegedly violated the False Claims Act because Medicare only reimburses healthcare providers for treatments that are deemed medically necessary. In this instance, Amedisys allegedly manipulated data to make patients appear sicker than they actually were, in order to justify extra, unnecessary therapy.

The lawsuit further alleged that these violations were the result of pressures from management on the nurses and therapists who provided patient care, to focus on the financial benefits to Amedisys, rather than the needs of the patients in their care.

This healthcare fraud settlement also resolves allegations that Amedisys violated the Anti-Kickback and Stark laws by maintaining improper financial relationships with referring physicians.  The Anti-Kickback Statute and the Stark Statute are laws that restrict the financial relationships that home healthcare providers may have with other healthcare providers who refer patients to them.  In this case, the government alleges that Amedisys had an improper financial relationship with a private oncology practice in Georgia, in which Amedisys employees provided patient care coordination services to the oncology practice at a lower cost, in exchange for patient referrals. This arrangement was deemed unlawful, as it violated the above-mentioned statutes.

This settlement resolves a total of seven lawsuits against Amedisys, which were filed by whistleblowers under the qui tam provisions of the False Claims Act. This qui tam, or whistleblower, provision allows for private citizens, also known as relators, to bring a lawsuit on behalf of the United States government, and for them to share in any monetary recovery from the suit.  A whistleblower’s portion of the recovery typically ranges between 15% and 30% of the total amount recovered.

For their part in the lawsuit against Amedisys, the qui tam whistleblowers in this case will collectively split over $26 million as their reward.

If you have information showing that a healthcare provider has committed fraud on a government healthcare program, such as Medicare, then you may be able to bring your own qui tam lawsuit under the False Claims Act. Through a qui tam lawsuit, you would help the government recover taxpayer money that has been paid as a result of fraudulent claims.