Amedisys to pay $43.8 million to settle Medicare fraud allegations

By Kacie Whaley | Jul 23, 2017

Home health care firm Amedisys Inc. has agreed to pay $43.8 million to settle a federal lawsuit that involved the company allegedly engaging in Medicare fraud.

BATON ROUGE — Home health care firm Amedisys Inc. has agreed to pay $43.8 million to settle a federal lawsuit that involved allegations that the company engaged in Medicare fraud.

In 2010, shareholders sued Amedisys and some of its executives over claims that the Baton Rouge healthcare company had inflated its financial results and share prices, according to the Advocate. The investors claimed that there were members of the company's board and management, which allegedly "expressly or implicitly approved" of the scheme that involved increasing health visits to receive more payments from Medicare.

Amedisys settled a lawsuit in 2014 in which the company agreed to pay the U.S. Department of Justice $150 million because of the Medicare scheme. The DOJ alleged that between 2008 and 2010, Amedisys billed Medicare for home nursing and therapy services that were either unnecessary or were for patients who were not homebound. The government agency also accused the company of doctoring patients' medical conditions in order to receive more Medicare payments.

"In recent years, in part through the Affordable Care Act, the Department of Justice and the Centers for Medicare and Medicaid Services has attempted to refocus efforts on identifying and stopping Medicare fraud," Gregory Stevens, a professor at the University of Southern California who specializes in health care reform and policy, told the Louisiana Record. "And each year, tens, if not hundreds, of individual physicians are singled out and prosecuted."

While health care providers have been punished for fraud before, it is fairly uncommon for violators to get caught in the act.

"Medicare fraud is a concern for the country, but it is not common for a health care facility to be caught engaging in fraudulent activity," Stevens said. "While there are few hard numbers on the actual amount of money that is lost to fraud each year, a range of estimates suggest that it accounts for 3 to 10 percent of Medicare spending. This is sizable."

Despite the accusations, Amedisys did not admit to any fraud during the DOJ case, according to the Advocate. Instead, the firm said it settled to avoid "uncertainties, risk, distraction and expense associated with this protracted litigation."

"It is often difficult to clearly establish that what was billed to Medicare inaccurately was done so intentionally," Stevens said. "Billing is complex and even well-meaning providers can have a pattern of billing Medicare that is not accurate. However, there are also cases where it is clearly fraud."

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