The government has intervened in a whistleblower lawsuit against A Plus Home Health Care, Inc., a home health care company in Fort Lauderdale, Fla., and its owner, Tracy Nemerofsky, the Justice Department announced today. The government alleges that A Plus offered referring physicians’ spouses sham marketing positions with the company to induce the physicians to refer Medicare patients for home health care services.
“Kickback schemes subvert the home health care market place and undermine the integrity of consumer choice,” said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division. “We will continue to hold accountable those who abuse our public health care programs at the expense of patients and taxpayers.”
The government alleges that, beginning in 2006, A Plus Home Health Care engaged in a scheme to increase Medicare referrals in the heavily saturated home health care market of southern Florida. The company allegedly hired at least seven physicians’ spouses and one physician’s boyfriend to perform marketing duties but required them to perform few, if any, actual job duties. To cover up the scheme, the government alleges, Ms. Nemerofsky generated sham personnel files, which included lists of job duties the spouses and boyfriend did not perform and performance reviews of job functions they did not complete, to give the false impression that the spouses and boyfriend were legitimate employees.
The government’s complaint also alleges that the spouses’ and boyfriend’s salaries were an inducement and reward for the physicians’ referrals of Medicare patients to A Plus Home Health Care. In fact, the government alleges the physicians’ referrals to A Plus Home Health Care spiked dramatically when the spouses and boyfriend began receiving paychecks from A Plus, allowing A Plus to receive millions of dollars in Medicare reimbursements. For example, in 2005, before A Plus hired any referring physicians’ spouses, A Plus was allegedly reimbursed $1.1 million from Medicare for home health care services. Conversely, in 2011, when A Plus was paying salaries to the seven referring physicians’ spouses and one physician’s boyfriend, A Plus’ Medicare reimbursement allegedly reached an all-time high of $6.6 million.
“We will not relent in our efforts to combat fraudulent kickback schemes, such as the no-show jobs scheme used in this case, and return dollars to the Medicare program,” said Wifredo A. Ferrer, U.S. Attorney for the Southern District of Florida. “These schemes are classic examples of the fraud and abuse that plague and threaten the financial stability of Medicare, which provides much needed services to the sick and elderly.”
According to an August 2012 Department of Health and Human Services’ Office of Inspector General report, home health services are particularly vulnerable to fraud, waste and abuse. In 2010, Medicare paid a reported $19.5 billion to 11,203 home health care agencies for services provided to 3.4 million beneficiaries.
The lawsuit was filed by a former A Plus Home Health Care director of development, William Guthrie, under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government and receive a share of any recovery. The act also authorizes the government to intervene in and assume primary responsibility for litigating the lawsuit, as the government has done in this case. The government previously settled with two of the couples that accepted payments from A Plus Home Health Care.
The government’s intervention in this lawsuit illustrates its emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $14.7 billion through False Claims Act cases, with more than $10.7 billion of that amount recovered in cases involving fraud against federal health care programs.
The A Plus Home Health Care investigation reflects a coordinated effort among the Commercial Litigation Branch of the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Southern District of Florida, the Department of Health and Human Services’ Office of Inspector General, and the Federal Bureau of Investigation.
The lawsuit is U.S. ex rel. Guthrie v. A Plus Home Health Care, Inc., 12 CV 60629 (S.D. Fla.). The claims asserted against the defendants are allegations only, and there has been no determination of liability.
Tags: A Plus Home Health Care, Department of Health and Human Services, Department of Justice, Eric Holder, False Claims Act, Health Care Fraud Prevention and Enforcement Action Team (HEAT), Kathleen Sebelius, Office of the Inspector General