Three Ohio based companies  – Foundations Health Solutions Inc. (FHS), Olympia Therapy Inc. (Olympia), and Tridia Hospice Care Inc. (Tridia) – and their executives, have agreed to pay approximately $19.5 million to resolve False Claims Act allegations that the companies billed Medicare for medically unnecessary rehabilitation therapy and hospice services.  The claims were originally brought to the government’s attention by two separate lawsuits filed under the qui tam provisions of the False Claims Act by former employees of the companies who witnessed the fraud.  The qui tam provisions of the False Claims Act allow private individuals with knowledge of fraud against the government to file a lawsuit on behalf of the United States and share in any recovery.  In this case, the whistleblowers will collectively share over $3.6 million.  The first whistleblower to file suit, a former Olympia employee, will receive approximately $2.9 million as his share of the government’s recovery and the second set of whistleblowers to file a qui tam action, also former Tridia employees, will collectively receive $740,000.

The settlement, announced by the Department of Justice on July 17, 2017, resolves allegations that from January 2008 through December 2012, the companies submitted, or caused the submission of, false claims to Medicare for medically unnecessary rehabilitation therapy services at 18 skilled nursing facilities. The government contended that the therapy services were provided at excessive levels to increase Medicare reimbursement for those services.

The settlement further resolves allegations that, from April 2011 through December 2013, Tridia submitted false claims to Medicare for hospice services provided to patients who were ineligible for the Medicare hospice benefit because Tridia failed to conduct proper certifications or medical examinations. The settlement also resolves allegations that from January 2008 through December 2012, Colleran and Parker solicited and received kickbacks to refer patients from skilled nursing facilities managed by the companies to Amber Home Care LLC, a home health care services provider.

“This is one of the largest nursing home operations in Ohio,” said U.S. Attorney Benjamin C. Glassman for the Southern District of Ohio. “It is unacceptable for an entity entrusted to care for our most vulnerable and elderly citizens to make decisions based on profit, not quality of care. Subjecting the elderly to inappropriate levels of therapy can be physically harmful, and failing to properly certify and re-certify hospice patients can have a devastating impact on the patients and their families.”

Frohsin Barger & Walthall would like to thank and congratulate the Department of Justice Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Southern District of Ohio, HHS-OIG, the HHS Office of Counsel to the Inspector General, and the Ohio Medicaid Fraud Control Unit for their coordinated efforts in resolving this case.

Frohsin Barger & Walthall would also like to thank and congratulate the brave whistleblowers and their counsel, Morgan Verkamp LLC in Cincinnati, Ohio and Hochman Plunkett Co. L.P.A. of Dayton, Ohio.

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Read the full Department of Justice press release here.