PruittHealth to pay $ 4.2 million to settle case over billing allegations

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A large Georgia-based healthcare company and its affiliates have agreed to pay $ 4.2 million to resolve allegations in a misrepresentation case involving its home healthcare business, federal officials said Monday.

In addition to providing home care services, PruittHealth, based in Norcross in the Atlanta metro area, is one of the largest nursing home chains in the South, with more than 50 such facilities in Georgia. .

Erskine

The government alleged that from January 1, 2011 to June 30, 2012, Pruitt knowingly submitted claims to Medicare and Medicaid for home health services that were not eligible for reimbursement. The claims were not eligible because they did not have the required face-to-face certifications or care plans, and they did not document the recipient’s homebound status or the need for home health services. federal officials said.

Pruitt learned he had received payments for home health services he was not entitled to, but did not disclose his receipt of overpayments or reimbursed overpayments in a timely manner, the officials said. government officials.

The settlement resolves a lawsuit originally filed in the United States District Court for the Northern District of Georgia by Tina Peery under the whistleblower provisions of the False Claims Act. Under this law, private citizens can sue for false claims on behalf of the United States and participate in any recovery obtained by the government.

Peery will receive more than $ 700,000 from the settlement.

The claims resolved by the settlement are only allegations, and there has been no determination of liability, according to the federal statement.

PruittHealth said on Monday that home health services were medically necessary and actually provided, and the quality of services was never in question.

Pruitt

“For over 50 years my family has strived to raise the standard of care provided in the profession, and we have maintained that reputation through our transparency and compliance,” said Neil L. Pruitt, CEO and President from PruittHealth, in a statement. Monday statement

“That’s why we took action when we recognized, regardless of this survey, that there was room for improvement in some home care centers. We have made every effort to ensure transparency and compliance.

US attorney Kurt R. Erskine said the Medicare and Medicaid programs “depend on providers to submit only claims eligible for reimbursement and to promptly notify programs if they receive payments to which they are not entitled.”

He added that “health care providers should not put their own financial well-being before their homework under Medicare and Medicaid programs.”

In entering into its deal with Pruitt, the federal government took into account documents produced by the company indicating that it had subsequently taken steps to improve compliance with the home health requirements of the Medicare and Medicaid programs. These actions included the recruitment of an external consultant in January 2013 to perform an audit of its health claims at home. Pruitt has also created a system of audits to ensure accurate invoicing.

The case was investigated by the United States Attorney’s Office for the Northern District of Georgia, the Office of the Inspector General of the United States Department of Health and Human Services, the FBI and the Georgia Medicaid Fraud Control Unit.

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