State-Federal Settlement Reached with Home Health
Agency and its Owners to Resolve False Claims Act Allegations
A Stratford-based home health agency and its owners have reached a $5.25 million settlement with the state of Connecticut and the federal government to resolve allegations that the company submitted false claims to Connecticut's Medicaid program, Attorney General George Jepsen said today. The settlement stems from a three-year investigation led by the Office of the Connecticut Attorney General after an audit by the Department of Social Services (DSS).
Family Care Visiting Nurse and Home Care Agency LLC (FCVNA) – owned and operated by David and Rita Krett – has offices in Stratford, Woodbridge, Norwalk and Meriden and provides home health services in Fairfield, Hartford, Middlesex and New Haven Counties. FCVNA is enrolled as a provider in the Connecticut Medical Assistance Program (CMAP), which includes the Connecticut Medicaid Program.
State and federal Medicaid regulations require a home health provider to assign a registered nurse (RN) to conduct an initial in-person assessment of the patient's medical condition and home health needs, and to create an initial patient plan of care based on that assessment. Thereafter, an RN must conduct an in-person assessment and review of the patient's plan of care at least once every 60 days. Further, when a patient's plan of care includes home health aide services, the RN is required to conduct in-person supervision of the home health aide in the patient's home at least once every 60 days.
The Attorney General's investigation developed evidence that, from January 2009 through April 2016, FCVNA knew that it did not comply with all federal and state Medicaid home health care provider requirements and falsely billed the Connecticut Medicaid Program for certain home health services. Specifically, the state and federal government alleged that FCVNA knowingly submitted claims for payment to the CMAP for RN visits to perform in-person assessments of Medicaid patients and in-person supervisory visits of home health aides, when, in fact, a significant number of these services that were billed by FCVNA were not performed by RNs.
Additionally, the state and federal government alleged that FCVNA engaged in a pattern and practice of prematurely "flipping" patients with dual eligibility for both Medicare and Medicaid between the two programs in order to take advantage of less restrictive Medicaid reimbursement requirements.
"Medicaid providers who choose to participate in the CMAP have a responsibility to ensure that they are in compliance with all applicable laws and regulations and are truthful when they submit claims for payment for services to the Medicaid program," Attorney General Jepsen said. "We will continue to work to hold accountable those who seek to defraud our taxpayer-funded healthcare programs. I am grateful to our partners in this investigation, especially the U.S. Attorney's Office for the District of Connecticut, the U.S. Department of Health and Human Services Office of Inspector General and Office of Investigations, the Connecticut Medicaid Fraud Control Unit and the Connecticut Department of Social Services Office of Quality Assurance, for their coordination and work in this case, and for the continued cooperation between agencies, both state and federal, as we work to protect our public healthcare programs."
DSS Commissioner Roderick L. Bremby, "This major investigation and settlement further indicate the need for strong financial oversight in our public medical assistance programs. I thank Attorney General Jepsen and his staff, as well as our other state and federal partners, for their outstanding work to safeguard fiscal integrity and protect taxpayer interests. I am also pleased to note that the investigation was based on a fraud referral following a regular audit by DSS Quality Assurance staff."
To resolve the investigation and allegations, FCVNA and David and Rita Krett have agreed to pay $5,253,908.54 to the state and federal government. The state of Connecticut's share of these funds is $3,152,345.12.
As part of the settlement agreement, FCVNA and David and Rita Krett have entered into a five-year corporate integrity agreement with the U.S. Health and Human Services, Office of Inspector General –and are required to engage an independent review organization to perform annual reviews of Medicare and Medicaid claims for reimbursement.
Today's action is part of a larger effort by the State of Connecticut's Interagency Fraud Task Force, which was created in July 2013 to wage a coordinated and proactive effort to investigate and prosecute healthcare fraud directed at state healthcare and human service programs. The task force includes a number of Connecticut agencies and works with federal counterparts in the U. S. Attorney's Office and the U.S. Health and Human Services, Office of Inspector General – Office of Investigations. For more information, please visit www.fightfraud.ct.gov
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at firstname.lastname@example.org
; the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney at 860-258-5986 or by email at email@example.com
; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud
, or by email to firstname.lastname@example.org
Assistant Attorneys General Karla Turekian and Antonia Conti, and Forensic Fraud Examiner Lawrence Marini, working under the direction of Assistant Attorney General Michael Cole, chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General with this matter.
Jaclyn M. Falkowski