Dallas-based Intrepid U.S.A. Inc. agreed to pay $3.85 million to resolve allegations that two lines of business for the home healthcare and hospice provider violated the False Claims Act, the U.S. Department of Justice (DOJ) said Aug. 20.
Intrepid agreed that it knowingly submitted claims to Medicare for home healthcare services for patients who did not qualify for the Medicare home healthcare benefit or where services otherwise did not qualify for Medicare reimbursement; and that it knowingly submitted claims to Medicare for patients who did not qualify for the hospice benefit. The settlement is based on Intrepid’s ability to pay, said the DOJ.
“Medicare’s hospice and home healthcare benefits provide critical services to vulnerable patient populations across the country,” said Principal Deputy Assistant Attorney General Brian Boynton, head of the DOJ’s Civil Division. “This settlement reflects our commitment to ensuring that these benefits are used to care for those who need them and not just to enrich those who seek to provide them.”
The U.S. government alleged that, between 2016 and 2021, 19 Intrepid home healthcare facilities submitted claims to Medicare for home healthcare services for patients who did not qualify or were not properly certified as eligible for the Medicare home healthcare benefit, where the services provided were not reasonable or medically necessary, where the services were provided by untrained staff, or where services were not performed, according to the DOJ.
Separately, the government alleged that, between 2016 and 2021, three Intrepid hospice facilities admitted patients to hospice care who were ineligible for the Medicare hospice benefit because they were not terminally ill or continued providing services to patients who should have been discharged because they no longer met the requirements for the Medicare hospice benefit.
“The Medicare Program provides vital health insurance to the elderly and disabled population,” said U.S. Attorney Michael Bennett for the Western District of Kentucky. “Our office will vigorously pursue unscrupulous providers who choose to illegally and improperly bill the Medicare Program.”
The civil settlement resolves claims brought under the whistleblower provisions of the False Claims Act in two different lawsuits.
The first action was brought by Jennifer Jones, a former travel nurse, and Pamela Joffe, a former director of Quality Assessment Performance Improvement and New Business Development at Intrepid.
The second action was brought by Marsha Rigney, a former director of Clinical Excellence and Integrity, and Janet Watts, a former regional manager of Clinical Excellence at Intrepid.
According to the DOJ, Jones and Joffe will receive $333,985 from the settlement proceeds, while Rigney and Watts will receive $359,014 from the settlement proceeds.
“Businesses [that] engage in improper Medicare billing practices undercut the legitimate provision of healthcare services for patients in need,” said U.S. Attorney Andrew Luger for the District of Minnesota. “This settlement reinforces the importance of holding accountable healthcare providers who seek financial gain above quality patient care.”
The resolution of these cases resulted from a coordinated effort between the DOJ’s Civil Division, Commercial Litigation Branch, Fraud Section, the U.S. Attorney’s Office for the Western District of Kentucky, and U.S. Attorney’s Office for the District of Minnesota.
“Home health is designed to increase healthcare access for our most vulnerable populations with mobility limitations, while hospice care aims to provide comfort and relief for the terminally ill. Exploiting these systems for financial gain is intolerable,” said Special Agent in Charge Tamala Miles of the U.S. Department of Health and Human Services Office of Inspector General, which assisted in the investigation.
“Working with our law enforcement partners, we will continue to pursue healthcare providers who jeopardize the integrity of these services by prioritizing profit over medically necessary palliative care,” Miles added.