by Ben Vernia | July 19th, 2013
On July 19, the Department of Justice announced that it was intervening in a qui tam, or whistleblower, suit, filed against a home health care company and its owner in Fort Lauderdale, Florida. According to DOJ’s press release:
The government has intervened in a whistleblower lawsuit against A Plus Home Health Care, Inc., a home health care company in Fort Lauderdale, Fla., and its owner, Tracy Nemerofsky, the Justice Department announced today. The government alleges that A Plus offered referring physicians’ spouses sham marketing positions with the company to induce the physicians to refer Medicare patients for home health care services.
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The government alleges that, beginning in 2006, A Plus Home Health Care engaged in a scheme to increase Medicare referrals in the heavily saturated home health care market of southern Fla. The company allegedly hired at least seven physicians’ spouses and one physician’s boyfriend to perform marketing duties but required them to perform few, if any, actual job duties. To cover up the scheme, the government alleges, Ms. Nemerofsky generated sham personnel files, which included lists of job duties the spouses and boyfriend did not perform and performance reviews of job functions they did not complete, to give the false impression that the spouses and boyfriend were legitimate employees.
The government’s complaint also alleges that the spouses’ and boyfriend’s salaries were an inducement and reward for the physicians’ referrals of Medicare patients to A Plus Home Health Care. In fact, the government alleges the physicians’ referrals to A Plus Home Health Care spiked dramatically when the spouses and boyfriend began receiving paychecks from
A Plus, allowing A Plus to receive millions of dollars in Medicare reimbursements. For example, in 2005, before A Plus hired any referring physicians’ spouses, A Plus was allegedly reimbursed $1.1 million from Medicare for home health care services. Conversely, in 2011, when A Plus was paying salaries to the seven referring physicians’ spouses and one physician’s boyfriend, A Plus’ Medicare reimbursement allegedly reached an all-time high of $6.6 million.* * *
According to an August 2012 Department of Health and Human Services’ Office of Inspector General report, home health services are particularly vulnerable to fraud, waste and abuse. In 2010, Medicare paid a reported $19.5 billion to 11,203 home health care agencies for services provided to 3.4 million beneficiaries.
The lawsuit was filed by a former A Plus Home Health Care director of development, William Guthrie, under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government and receive a share of any recovery. The act also authorizes the government to intervene in and assume primary responsibility for litigating the lawsuit, as the government has done in this case. The government previously settled with two of the couples that accepted payments from A Plus Home Health Care.
