PruittHealth, Inc. and affiliated entities (“Pruitt”) have agreed to pay $4.2 million to resolve allegations that they submitted claims for home health services that were not covered by the Medicare and Medicaid programs, and that they failed to refund overpayments that they had received from Medicare and Medicaid in a timely manner. The Government alleges that from January 1, 2011 through June 30, 2012, Pruitt knowingly submitted claims to Medicare and Medicaid for home health services that were not eligible for reimbursement because, among other things, they did not have the required face-to-face certifications or plans of care, and they did not document the beneficiary’s homebound status or need for the home health services. The Government further alleges that Pruitt learned that it had received payments for home health services to which it was not entitled, but failed to disclose its receipt of the overpayments, or refund the overpayments to Medicare and Medicaid in a timely manner.
In reaching its settlement with Pruitt, the Government took into account documents produced by Pruitt indicating that Pruitt subsequently took steps to improve its compliance with the home health requirements of the Medicare and Medicaid programs, including the retention of an outside consultant in January 2013 to conduct an audit of its home health claims, the implementation of a pre-bill review of home health claims between February 2013 and August of 2013, and the implementation of quarterly audits of its home health claims (with more frequent audits as needed) beginning in September 2013 through the present. Pruitt voluntarily produced the results of its 2013 audit to the Government during the investigation. Although the Government has taken these steps into consideration, this is not an indication or concession as to the sufficiency of these compliance measures.
