Amedisys, Inc. Settles Civil False Claims Act Liabilities for $150 Million
PHILADELPHIA and BOSTON, April 23, 2014
PHILADELPHIA and BOSTON, April 23, 2014 /PRNewswire/ -- The United States
Department of Justice and several whistleblowers have reached an agreement
with Louisiana based home healthcare provider Amedisys, Inc. ("Amedisys") to
resolve civil fraud liabilities under the Federal False Claims Act ("FCA") for
$150 million. In addition to paying a $150 million civil settlement, Amedisys
will be bound by a Corporate Integrity Agreement ("CIA") with the Office of
Inspector General of the United States Department of Health and Human Services
("OIG-HHS"). This settlement is, by far, the largest home healthcare
settlement in the history of the FCA, and concludes multiple whistleblower
suits, including one brought by CAF Partners, represented by Suzanne Durrell
of Durrell Law Office and Robert M. Thomas, Jr. of Thomas and Associates,
affiliates of the Whistleblower Law Collaborative, and Tavy Deming and Emily
Lambert of Kenney & McCafferty.
This settlement marks the successful conclusion of a nearly six year effort by
CAF Partners to expose fraudulent practices by home health behemoth Amedisys.
While the case was filed in 2010, in fact, actions by one of the partners date
back to September 2008 when, voluntarily, and out of a sense of duty, the
individual placed a call to a regional office of the OIG-HHS. On that call,
and over the course of a year of follow-up discussions with the government,
the individual articulated well-founded allegations regarding a systematic
manipulation of data by Amedisys to make patients appear sicker than they
actually were in order to justify extra, unnecessary therapy visits to qualify
for bonus payments under the Medicare Home Health Prospective Payment System
("PPS"). "The taxpayers should be very grateful that someone came forward and
then persevered in making the government aware of Amedisys' wrongdoing.
Medicare is essentially an honor system under which CMS pays first and chases
later; too many times, CMS does not know who to chase, but thankfully here
they were given a roadmap and the Department of Justice followed it," said
Suzanne Durrell of Durrell Law Office. "We are proud to represent individuals
who help make the system work." said Robert M. Thomas, Jr., of Thomas and
The members of CAF Partners who joined with this individual also brought
unique and valuable insight into the use, and impact, of Amedisys's
proprietary software system. Through this system, CAF Partners alleged that
Amedisys sought, not only, to admit, and subsequently recertify, patients to
home health care that did not meet the Medicare guidelines for services, but
also targeted patients for recertification in order to qualify for higher
reimbursement from Medicare. "Rather than 'drink the Kool-Aid,' CAF Partners
called out Amedisys for picking the taxpayers' pockets through pushing
aggressive overutilization of home health services, including most notably
through its signature program Balanced for Life, for which the admission
criteria was made purposefully amorphous, so nearly every patient qualified,"
according to Tavy Deming of Kenney & McCafferty. Added Deming, "Amedisys
continued to pad its soaring Medicare profits by revamping its menu of therapy
programs to hit revised Medicare therapy bonus thresholds that to took effect
in 2008." Suddenly in 2008, diagnoses for which Amedisys previously provided
10 or 11 therapy visits – since prior to 2008, 10 therapy visits triggered a
Medicare therapy bonus payment - required an increased number of visits that
tracked the revised Medicare therapy bonus thresholds of 6, 14, and 20.
"Our client had a tremendous amount of evidence relating to practices
including Balanced for Life and is extremely pleased with the knowledge that
its information contributed to the curbing of practices utilized to drive
corporate profits," said Emily Lambert of Kenney & McCafferty.
The lawsuit was filed in May 2010 in the Eastern District of Pennsylvania
under the qui tam, or whistleblower, provisions of the False Claims Act.
These provisions permit private parties to sue on behalf of the United States
when they believe an individual or company has submitted false claims for
government funds. In successful qui tam actions in which the Government
intervenes, whistleblowers are entitled to receive a percentage of the funds
recovered, typically 15 to 25 percent, known as a "relator's share." Relator
CAF Partners will receive a portion of the more than $25,500,000.00 million
relator's share awarded in this case.
Relator CAF Partners as well as its counsel praised the efforts and approach
of the federal government'sinvestigation into Amedisys' conduct, a
collaborative effort led by Lisa K. Samuels, Trial Attorney with the Justice
Department's Civil Fraud Section, and Assistant US Attorneys Gregory David and
Eric Gill of the US Attorney's Office for the Eastern District of
Pennsylvania, Assistant US Attorney Lane Woodke, Civil Division Chief, of the
US Attorney's Office for the Northern District of Alabama, and Assistant US
Attorney Christopher Huber of the US Attorney's Office for the Northern
District of Georgia, alongside agents from OIG-HHS."This case is a wonderful
example of a successful and effective partnership between the Government and
Relators" said Attorney Durrell. "We were able to work very closely with the
Government and provided valuable assistance over the course of the multi-year
investigation; our clients are very grateful for the government's hard work
and cooperation," continued Attorney Lambert.
This case is the latest in a string of health care fraud whistleblower
settlements in which the Whistleblower Law Collaborative
www.whistleblowerlawcollaborative.com and/or Kenney & McCafferty
www.kenneymccafferty.com have been involved as counsel for the whistleblowers.
This is the first time these two pre-eminent whistleblower firms have acted as
co-counsel for a relator, a team effort that proved very successful.
The case is captioned United States ex rel. CAF Partners v. Amedisys, et al.
Civ. No.:10-cv-02323 (E.D. PA).
SOURCE Kenney & McCafferty, P.C.; The Whistleblower Law Collaborative
Contact: Whistleblower Law Collaborative: Suzanne Durrell, (617) 371-1072,
firstname.lastname@example.org, or Bob Thomas, (617) 371-1072,
email@example.com; or Kenney & McCafferty, P.C.: Tavy Deming, (215)
367-4333, firstname.lastname@example.org, or Emily Lambert, (215) 367-4333,
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