In April 2014, the United States Department of Justice and several whistleblowers reached an agreement with home healthcare provider Amedisys, Inc. to resolve civil fraud liabilities under the Federal False Claims Act (“FCA”) for $150 million. In addition to paying the $150 million civil settlement, Amedisys agreed to 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).
The settlement concluded a nearly six year effort to expose fraudulent practices by Amedisys which detailed 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. In addition, 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.
