Home health provider PruittHealth will pay $4.2 million to resolve allegations that it submitted claims for services that were not covered by Medicare and Medicaid programs, and that it failed to refund overpayments in a timely manner, according to the DOJ’s U.S. Attorney’s Office for the Northern District of Georgia.
The settlement resolves allegations only, and there has been no determination of liability, the DOJ noted in its statement.
The patient claims under issue were between Jan. 1, 2011, and June 30, 2012. According to the DOJ, Pruitt allegedly knowingly submitted claims to Medicare and Medicaid for home health services that were not eligible for reimbursement because, among other things, they did not have the required face-to-face certifications or plans of care, and they did not document the beneficiary’s homebound status or need for the home health services. Pruitt is also accused of failing to disclose its receipt of the overpayments, or refund the overpayments to Medicare and Medicaid in a timely manner.
In a statement, Pruitt said that the allegations resolved in the settlement involved Medicare paperwork and that the "home health services were medically necessary and actually provided, and the quality of service was never at issue."
In reaching its settlement with Pruitt, the Government took into account documents produced by Pruitt indicating that Pruitt subsequently took steps to improve its compliance with the home health requirements of the Medicare and Medicaid programs, including the retention of an outside consultant in January 2013 to conduct an audit of its home health claims, the implementation of a pre-bill review of home health claims between February 2013 and August of 2013, and the implementation of quarterly audits of its home health claims (with more frequent audits as needed) beginning in September 2013 through the present, the DOJ statement noted.