A home healthcare operation providing service to patients in rural Alabama recently settled a whistleblower lawsuit, agreeing to pay the United States government $150,000 to resolve claims that it violated the federal False Claims Act. Techota, LLC, whose headquarters is located in Nashville, Tennessee, provides home healthcare services in Alabama using the names CV Home Health of Bibb County and CV Home Health Services. Techota allegedly submitted false reimbursement claims to Medicare for the home healthcare services of multiple patients who were not home-bound.
According to the official court documents, Techota attempted to create the false appearance that numerous patients required skilled home care and were eligible to receive Medicare home health benefits. Techota then knowingly submitted the fraudulent claims to Medicare and later received reimbursement, which are violations of the federal False Claims Act.
According to the terms of the settlement, in addition to the $150,000 fine, Techota also agreed to enter into a corporate integrity agreement with the Department of Health and Human Services Office of Inspector General (OIG). A corporate integrity agreement is often a requirement of settlement negotiations in a federal healthcare program investigation and outlines specific obligations that a healthcare entity must abide by as part of its civil settlement. The corporate integrity agreement essentially allows officials to keep a watchful eye on healthcare providers with a history of False Claims Act violations. In exchange for entering into the agreement, the OIG agrees not to exclude the provider from participating in Medicare, Medicaid and other federally-sponsored healthcare programs.
As a result, if Techota were to breach its corporate integrity agreement with the federal authorities, it can be forced to turn over any undisclosed assets and pay up to a $4.1 million fine, plus penalties and interest.
Allegations of Medicare Fraud
The original whistleblower complaint, filed in 2011, included allegations that Techota and its subsidiaries, Cahaba Valley Health Services and Cahaba Valley Home Health, knowingly and willfully caused false claims to be submitted to Medicare. Many of Techota’s patients were allegedly not home bound, yet Techota provided them with medically unnecessary healthcare services and billed Medicare for the fraudulent services.
For Medicare to cover home healthcare services, beneficiaries must be home bound or unable to leave their homes without considerable effort or difficulty. Patients who are able to come and go as they please, easily drive to their doctor’s offices and get around with little to no problem are considered ineligible for home healthcare services. On the other hand, those patients who are physically unable to leave their home, drive an automobile or independently care for their medical condition are model candidates for home healthcare services.
Among the examples of home healthcare fraud cited in the whistleblower’s complaint, some stand out more than others. One of the more outrageous claims involved a patient who requested that his home healthcare nurses make their daily visits to his place of employment, as he was “too busy to be home every time the nurses came to provide treatment.”
Other allegations within the complaint include specific nurses who, instead of providing skilled medical care to their patients, did nothing more than deliver packages of cigarettes to patients and then watched television with them for extended periods of time.
The whistleblower, or qui tam, lawsuit was filed in 2011 by Veronica McDonald. A licensed registered nurse, McDonald was previously employed as an agency director by Cahaba Valley in October 2010.
While working at Cahaba Valley, McDonald says she almost immediately became aware of the fraudulent billing practices used by Techota. She became disturbed by the false representation of the type and severity of the patients’ medical conditions, but was consistently told to falsify and revise patient assessments or nursing notes. After consulting with a reputable False Claims Act attorney, McDonald decided to file an official complaint.
As the whistleblower for this case, McDonald will receive a relator’s share of $22,500.