Skip to content Skip to navigation

Kentucky Home Care Provider Admits to Overbilling Medicare with Help of EHRs

July 11, 2016
by Rajiv Leventhal
| Reprints

A  Louisville, Ky.-based provider of home-based care has agreed to pay millions to resolve a government lawsuit alleging that the organization knowingly submitting false medical claims to Medicare and other government healthcare programs, altered records to support false claims, and provided services that were medically unnecessary.

The government’s complaint alleged that between 2007 and 2014, the provider, MD2U Holding Company, including its related companies and individually named owners, submitted false billings for patients who were neither homebound nor home-limited; improperly billed the government for medically unnecessary visits; billed government healthcare programs at the highest payment codes (upcoding) when a lower code would have been more appropriate; and cloned medical records (a cut, copy, paste electronic program) in order to justify patient visits.

According to its website, MD2U has more than 160 employees including dozens of providers and patient care coordinators. MD2U’s house calls have doubled every year since its inception and the company made over 70,000 house calls in 2012.

Specifically regarding electronic health records (EHRs), the government complaint alleged that MD2U also “utilized an EHR system that permitted non-physician providers (NPPs) to easily electronically cut, copy and paste medical notes from prior visits.  The ability to migrate notes from visits that occurred weeks, months, or even years prior to the current patient encounter created the illusion that MD2U’s NPPs were performing a significant amount of work during their patient encounters when, in fact, they were not.  If the documentation was deficient to bill the highest level code, MD2U would direct NPPs to go back and change the medical record—after the encounter had occurred—to falsely show that more work was performed during the visit in order to support the highest level billing,” according to the complaint.

Through a stipulation and order to be entered by the court, the defendants have admitted that they violated the False Claims Act, by (a) making or causing others to make false statements and (b) submitting or causing others to submit false claims to the United States.  The defendants admit that these actions caused damages and that they are liable to the United States in the amount of $21,511,756 under the False Claims Act (which allows for damages in the amount of three times the government’s loss, plus penalties), according to the Department of Justice.

Further, in the consent judgment to be entered by the court, multiple MD2U senior officials, all owners, residing in Louisville, admit that, due in part to the actions of a former employee, they caused the submission of false claims to the United States in violation of the False Claims Act.  They further admit that the submission of the claims for payment caused these damages as a result of misrepresentations, false representations and/or deceptive conduct; that it was done with reckless disregard of the falsity of the claims; and in doing so, caused the United States to be deceived.

“Unfortunately, our healthcare system is under assault from a small minority of providers who engage in fraudulent billing, overbilling and providing unnecessary services,” U.S. Attorney John E. Kuhn Jr. for the Western District of Kentucky said in a statement. Special Agent in Charge Derrick L. Jackson for the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) in Atlanta, added, “This provider billed for medically unnecessary home visits and often grossly exaggerated the level of service provided. The OIG is committed to protecting the integrity of federal health care programs by aggressively pursuing entities that increase their revenue through deceitful schemes and trickery.”



CMS Hospital Compare Website Updated with VA Data

The Centers for Medicare & Medicaid Services (CMS) has announced the inclusion of Veterans Administration (VA) hospital performance data as part of the federal agency’s Hospital Compare website.

CMS Awards Funding to Special Innovation Projects

The Centers for Medicare & Medicaid Services (CMS) has awarded 20, two-year Special Innovation Projects (SIPs) aimed at local efforts to deliver better care at lower cost.

Center of Excellence in Genomic Science to be Established in Chicago

The National Human Genome Research Institute has awarded $10.6 million over five years for the establishment of a new research center in Chicago to advance genomic science.

EHNAC and HITRUST Combine HIPAA Security Criteria, CSF Framework

The Electronic Healthcare Network Accreditation Commission (EHNAC) and the Health Information Trust Alliance (HITRUST) announced plans to streamline their accreditation and certification programs.

Halamka on MACRA Final Rule: “CMS is Listening and I Thank Them”

Health IT notable expert John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center in Boston, recently weighed in on the Medicare Access and CHIP Reauthorization Act (MACRA) final rule.

Texas Patient Care Clinic Hit with Ransomware Attack

Grand Prairie, Texas-based Rainbow Children's Clinic was the victim of a ransomware attack on its IT systems in August, affecting more than 33,000 patients, according to multiple news media reports this week.