Consider the case of the Nurses Registry and Home Health Corporation, based in Lexington, Kentucky. Owner and Executive Director Vickie House owes $16 million to the US government for perpetrating widespread home healthcare fraud throughout her agency.
Nurses Registry engaged in systematic false billing, violating the federal False Claims Act. The staff falsified medical records to make it appear as if patients had a medical need for skilled nursing or therapy services or appear as if the patients were homebound. Employees also forged physician signatures to “certify” that the patient required home care services and re-certified patients for more and more home healthcare services, billing services long after patients stopped meeting eligibility requirements.
The agency also provided tickets to events like the Kentucky Derby and Taylor Swift concerts and delivered bottles of liquor and other “enticements” to referral sources to ensure a flow of patients. This activity violated the federal Anti-Kickback Statute and the Stark Law prohibiting home healthcare agencies from billing for services referred to them by physicians with whom they have a financial relationship. Between 2005 and 2009, Medicare paid Nurses Registry more than $100 million, with a net income to the agency of $20.5 million.
To read the full article, visit the American Journal of Managed Care.