ld people don’t like leaving their homes. They especially don’t like moving out of the home that they’ve lived in for 20 or 30 years. And they especially don’t want to be moved to a nursing home (aka senior living community aka elder care facility aka retirement home). But old people also tend to need more medical care than others.
And so there’s a whole industry of in-home nursing care for seniors. Stay in your home and get the medical treatment you need without having to climb down steps, get into a car, or spend hours in a waiting room at a clinic.
It’s all described in the name: in-home nursing care. The care happens in the home by a nurse. A google image search makes that quite clear. See, it’s care from a nurse in the home.
In home care means . . . wait for it . . . in home care.
Atlantic Home Health Care must have known that. After all, it’s right there in their name. Home Health Care. But they did not provide that care. Instead, they billed the Energy Employees Occupational Illness Compensation Program when its employees were not physically present in patients’ homes. But you can’t do that. The whole point is that you’re supposed to be in-home! Just look at the picture. Without the in-home care, you’re just billing for nothing. That’s not how anything works.
Oh, and kickbacks too.
On top of that, Atlantic also paid kickbacks for referrals in the form of cash payments up to $5,000 for patient referrals via its “friends and family program” and in-kind payments for food, internet, travel and other expenses made to patients and their families. Yeah, that’s pretty clearly illegal.
As the United States notes in its press release, any of those types of arrangements are illegal:
The Anti-Kickback Statute prohibits parties who participate in federal healthcare programs, such as the Energy Program, from knowingly and willfully paying or receiving any remuneration in return for referring an individual to, or arranging for the furnishing of, any item or services for which payment is made by, the federal healthcare programs.
This case also features a textbook example of what to do when you get caught: self report. Here, Atlantic voluntarily disclosed the kickbacks and the United States acknowledged AHH’s cooperation in this regard. That’s good and exactly how to respond. It’s why the majority of the money is going to restitution and not to fines or punitives. Atlantic saved itself some money there.
According to Compliance Week, Tonya Cass, a former corporate administrator and director of human resource administration and management at Atlantic Home Health Care, will receive about $1.7 million as a whistleblower acting under the qui tam provisions of the False Claims Act.