In a rare turn of events, the Department of Justice has actually commended Michigan-based Portage Hospital, LLC after it opted to self-report various perceived violations of the False Claims Act by a member of its physical therapy staff.
The U.S. Attorney’s Office said in a statement:
“Portage Hospital is to be commended for disclosing this matter….Self-disclosures by providers are critical to protecting the integrity of federal healthcare programs. My office is committed to bringing voluntary disclosures to resolution as quickly and efficiently as is reasonably possible.”
While self-disclosures of healthcare fraud are few and far between, the underlying facts of today’s case represent a trend of home-based healthcare fraud that whistleblowers ought to be on the lookout for, particularly in light of the strict and specific Medicare and Medicaid guidelines pertaining to the provision of medical care in a patient’s home.
The case against Portage Hospital, LLC, resulted in a settlement of $4,446,392.43, which represents a “significantly reduced penalty” due to the defendant’s timeliness and honesty.
Details of the self-disclosed false claims
The false claims involving Portage Hospital involved its home-healthcare department, specifically known as Portage Health Home Care & Hospice. This group offers medical care and nursing services to patients who are unable to travel to a clinic or doctor’s office for reasons related to their underlying condition. However, receiving healthcare in the home is much more costly than receiving the same treatment in a clinic setting and government regulations limit the type of patients eligible for this service.
For a period spanning from January 2006 through November 2013, a Portage home care staff physical therapist is reported to have initiated between 1,889 and 3,352 home visits for purposes of engaging patients in physical therapy. While physical therapy can be a valid component to home healthcare services, this staff member regularly visited homes and engaged patients in therapy services that were not medically necessary or part of the patient’s treatment plan. In addition, upon review of the therapist’s visits, many visits were not properly documented as required by federal regulation, which also created a problem under the False Claims Act. Overall, many of the patients receiving physical therapy from this staff member were either not in need of such services or did not meet the “homebound” requirements described herein.
Whistleblower opportunities in the home healthcare industry
Our blog has regularly reported ongoing problems in the home healthcare industry and the trend appears to be continuing. Presumably, home healthcare providers are not under the same direct and constant supervision as nurses and staff members within the hospital setting, so they may feel more inclined to stray from proper billing protocols. Whatever the reason, billing for costly home healthcare services that do not meet regulatory guidelines results in an unnecessary burden on taxpayers and can be reduced by holding these providers accountable.
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