A large Georgia-based health care company and its affiliates have agreed to pay $4.2 million to resolve allegations in a false-claims case involving its home health business, federal officials announced Monday.
Besides providing home care services, PruittHealth, based in Norcross in metro Atlanta, is one of the South’s largest nursing home chains, with more than 50 such facilities in Georgia, including in Rome.
The government alleged that from Jan. 1, 2011, through June 30, 2012, Pruitt knowingly submitted claims to Medicare and Medicaid for home health services that were not eligible for reimbursement.
The claims were ineligible because 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, federal officials said.
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 in a timely manner, the government officials said.
The settlement resolves a lawsuit originally filed in the U.S. District Court for the Northern District of Georgia by Tina Peery under whistleblower provisions of the False Claims Act. Under that act, private citizens may bring suit for false claims on behalf of the United States and share in any recovery obtained by the government.
Peery will receive more than $700,000 from the settlement.
The claims resolved by the settlement are allegations only, and there has been no determination of liability, the federal statement said.
PruittHealth said Monday that the home health services were medically necessary and actually provided, and the quality of services was never at issue.
“For more than 50 years, my family has worked to elevate the level of care provided in the profession, and we’ve upheld this reputation through our transparency and compliance,” Neil L. Pruitt, CEO and chairman of PruittHealth, said in a statement Monday
“That’s why we took action when we recognized, independent of this investigation, there was opportunity for improvement at select home health locations. We’ve gone to great lengths to ensure transparency and compliance.”
U.S. Attorney Kurt R. Erskine said the Medicare and Medicaid programs “depend on providers to submit only those claims that are eligible for reimbursement and to promptly notify the programs if they receive payments to which they are not entitled.”
He added that “health care providers must not place their own financial well-being ahead of their duties under the Medicare and Medicaid programs.”
In reaching its settlement with Pruitt, the federal government took into account documents produced by the company indicating that it subsequently took steps to improve compliance with the home health requirements of the Medicare and Medicaid programs.
These actions included the retention of an outside consultant in January 2013 to conduct an audit of its home health claims. Pruitt also created a system of audits to ensure accurate billing.
The case was investigated by the U.S. Attorney’s Office for the Northern District of Georgia, the U.S. Department of Health and Human Services Office of Inspector General, the FBI and the Georgia Medicaid Fraud Control Unit.