Carenow Services, LLC, a psychotherapy services provider based in Roswell, Ga., And its CEO Leena Karun, have addressed whistleblower allegations that they billed federal medical programs for unnecessary, poorly documented, or less serious services than those represented in the billing. Carenow agreed to pay $ 2 million to resolve claims that they violated the Misrepresentation Act falsely billing Medicaid and Medicare for psychotherapy sessions at skilled nursing facilities and nursing homes.
According to a US Department of Justice (DOJ) Press release, between 2012 and 2018, Carenow allegedly billed the government for services rendered to patients who did not need them. These services consisted of psychotherapy sessions in nursing homes and specialized nursing facilities when medical records showed that the patients in question had no documented medical need for them. The government also alleged that Carenow was billing higher levels of medical services than actually provided, further increasing billing for federal medical programs. The process of upgrading the cost of services to more expensive services is known as “bottom-up coding” and this practice is a potential violation of the false claims law.
“Indiscriminately billing the government for psychotherapy services without considering medical needs or the intensity of treatment robs taxpayers of valuable federal health care resources,” said Acting US Attorney Kurt R. Erskine. âWe remain committed to investigating healthcare fraud, especially schemes that target the most vulnerable in our communities. Those who commit healthcare fraud should know that they risk significant federal fines, penalties and even jail time. “
Overloading and overcoding Medicaid and Medicare are types of fraud that have real effects on the efficiency of the medical system and the experiences people have with it. A model of overcharging for services can drive up the prices of the entire medical system, making it more difficult for people to pay for care and health insurance. It also reinforces mistrust of the medical system and healthcare professionals by taking advantage of patients. Medical fraudsters who run schemes in retirement homes and care facilities also target one of the most vulnerable demographic groups of the American population: the elderly and the infirm.
The anonymous whistleblower in this matter will receive a reward for bringing this matter to the attention of the government. Who tam whistleblowers, or storytellers as they are legally called, are entitled to 15-30% of the total money collected by the government as part of a settlement or action under the False Claims Act. The DOJ has yet to announce the amount of the Whistleblower Reward.
Less than two weeks ago, the Department of Justice announced a similar settlement under the False Claims Act, which concerned coding and unnecessary “speech, physical and professional services” in a health care facility. Chicago suburb. Medical fraud accounts for $ 1.8 of the total of $ 2.2 billion recovered by the False Claims Act in 2020.
WNN recently reported on the removal of a set of False Claims Act amendments from the Bill on infrastructure 2021. The An Act to amend the Misrepresentation Act reportedly made a number of critical changes to the law, making it more difficult for defendants to have cases dismissed, even after fraud has already been proven, on the basis of “materiality”. The amendments were removed due to a last-minute lobbying campaign by the American Hospital Association (AHA), a group whose voters could benefit from maintaining the current definition of ‘materiality’, WNN say the sources. The changes would also have prevented employers from firing employees so that they could then legally retaliate against them for reporting.
Read WNN article on removing FCA changes here.
Read more Misrepresentation Law /qui tam news on WNN.