A home health agency which is based in North Carolina agreed to pay $45,486.76 to settle a civil False Claims Act allegation related to allegedly fraudulent billings for purported work by a recently convicted felon who was employed by the agency as a CNA.
The North Carolina home health agency provides home health services and other services to patients, including veterans of the United States Armed Forces. In 2015 and 2016 the agency billed the Department of Veterans Affairs (VA) for home health services allegedly provided to an Army veteran. At the time, the veteran was living with one of the home healthcare employees who was a Certified Nurse’s Aide (CNA). The North Carolina home health agency based its billing for the services on falsified timesheets provided by the CNA who failed to provide the amount of time or quality of care required under the VA program. There were instances that the CNA provided timesheets that indicated she provided care to the Army veteran at the same time she was providing care to a different patient.
The Army veteran lived with the CNA for several months and was receiving home health services provided through the North Carolina home health agency. He was admitted to a hospital with severe pressure injuries and malnutrition, and died a few days after being admitted to the hospital.
The agency submitted 15 different claims seeking payment from the VA for services that were supposedly provided by the CNA to the veteran between October 2015 and December 2016 for a total of $11,273.92. However, the federal False Claims Act mandates that the government recover three times the damages caused by the fraud, plus civil penalties for false or fraudulent claims. Therefore, the agency agreed to pay $45,486.76 to resolve the claims.
The CNA was convicted of wire fraud for misconduct related to the Army veteran and was sentenced to 12 months and 1 day in federal prison in early 2021. The CNA was also ordered to pay restitution of more than $90,000.
United States Attorney Michael F. Easley, Jr., stated, “The home-health services provided to the veteran by his supposed care-giver were deplorable. Our veterans should be honored and respected for their service, not abused for others’ financial gain. The United States will always pursue justice for them, and for the programs in place to help support them. This case, on both the criminal and civil side, embodies that unwavering commitment.”
Compliance Perspective
Issue
All members of the healthcare team must be aware of what may be considered a false claim. Failure to promptly report a suspected or known false claim can result in lawsuits, fines, and other sanctions. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 1 Compliance and Ethics Program, CP 2.3 General Legal Duties and Antitrust Laws.
Discussion Points
- Review policies and procedures for preventing and reporting a false claim. Update your policies and procedures as needed.
- Train all staff on the False Claims Act and what can be considered a false claim. Include information on how to report concerns and suspected violations, and that prompt reporting is mandatory. Document that the trainings occurred and place in each employee’s education file.
- Periodically audit staff understanding to ensure that they are aware of what should be done if they suspect a false claim has occurred, whether intentionally or unintentionally. Conduct audits of documentation and billing routinely to prevent and detect errors before they progress to a false claim.
FOR MORE INFORMATION ON THIS TOPIC VIEW: FRAUD MODULE 3 – MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS.
