NEW ORLEANS (AP) — Amedisys Inc., a Baton Rouge-based home health company, will pay $150 million to resolve allegations that it inflated Medicare billings and had improper financial relationships with referring physicians, the U.S. Department of Justice said Wednesday.
Amedisys and its affiliates make up one of the nation's largest home health providers, operating in 37 states, Washington, D.C., and Puerto Rico, according to a Justice Department news release.
The company did not immediately return a call for comment.
The settlement does not admit guilt, prosecutors noted.
The agreement resolves False Claims Act allegations that, between 2008 and 2010, some Amedisys offices billed Medicare for unnecessary services and for patients who were not homebound, and misrepresented patients' conditions to increase its Medicare payments.
"These billing violations were the alleged result of management pressure on nurses and therapists to provide care based on the financial benefits to Amedisys, rather than the needs of patients," according to the news release.
The settlement also resolves seven whistleblower lawsuits, six in Pennsylvania and one in Georgia. The whistleblowers, mostly former Amedisys workers, will split more than $26 million.
Prosecutors also alleged that Amedisys workers coordinated patient care at below-market prices for a private cancer practice in Georgia that referred patients to the company.
Amedisys' financial relationship with a private oncology practice in Georgia — whereby Amedisys employees provided patient care coordination services to the oncology practice at below-market prices — violated statutory requirements.
"Home health services are a large and growing part of our federal health care system," said Sally Quillian Yates, U.S. attorney for the Northern District of Georgia. "Health care dollars must be reserved to pay for services needed by patients, not to enrich providers who are bilking the system."
Federal prosecutors in Alabama, Kentucky, South Carolina and New York State also worked on the case.
Company officials also signed an agreement with the Department of Health and Human Services' office of inspector general, requiring the company and its affiliates to set up measures designed to avoid or promptly detect conduct similar to that which gave rise to the settlement.