Carter Healthcare LLC, an Oklahoma-based for-profit home health care provider, its affiliates CHC Holdings and Carter-Florida (collectively Carter Healthcare), and their president Stanley Carter and chief operating officer Bradley Carter have agreed to pay $7.175 million to resolve the allegations , that they violated the False Claims Act by billing the Medicare program for medically unnecessary therapy provided to patients in Florida. Bradley Carter will pay $175,000, Stanley Carter will pay $75,000 and Carter Healthcare will pay the remaining $6.925 million of the settlement.
Between 2014 and 2016, Carter Healthcare is alleged to have knowingly and improperly billed the Medicare program for home health care services to Florida patients based on therapy provided without consideration of medical necessity and overcharged therapy by coding diagnoses of the patients.
“Medicare payment for home health care is authorized only for those who provide medically necessary services to eligible beneficiaries,” said Principal Deputy Assistant Attorney General Brian M. Boynton, chief of the Department of Justice’s Civil Division. “As this agreement demonstrates, the Department is committed to ensuring that providers bill only for appropriate procedures and amounts.”
“Medicare fraud costs our taxpayers billions a year,” said U.S. Attorney Juan Antonio Gonzalez, U.S. Attorney for the Southern District of Florida. “These overpayments deplete the Medicare trust fund and unfairly raise the premiums our senior citizens must pay. We take this fraudulent activity very seriously and will continue to pursue it to the full extent of the law.”
“This settlement is a stark reminder to home health care providers that our agents are working tirelessly with the Department of Justice to pursue providers who improperly bill federal health care programs to increase profits, as alleged here,” said Special Agent in Charge Omar Perez Aybar of the Office of the Inspector General of the Department of Health and Human Services (HHS OIG), Miami Regional Office. “Our agency will not hesitate to investigate such allegations to protect federal health care programs and the patients served by those programs.”
Both Stanley Carter and Bradley Carter agreed to be excluded from participation in all federal health care programs for a period of five years pursuant to 42 USC § 1320a-7(b)(7), the statutory authority to exclude from federal health care programs individuals or entities, who have engaged in fraud or bribery.
Carter Healthcare also agreed to be bound by the terms of a corporate integrity agreement with the Department of Health and Human Services – Office of Inspector General, which requires the company to implement compliance measures designed to avoid or promptly detect conduct similar to what has led to the settlement.
The settlement includes resolution of a lawsuit filed by Sharon Mahaffey and Mark Brymer, therapists who were former employees of Carter Healthcare, under who there or the False Claims Act filing provisions. These provisions allow a private individual to sue on behalf of the United States for false claims and receive a portion of any recovery. The case is overwritten US ex rel. Mahaffey and Brimer v. Carter Healthcare, Stanley Carter and Brad Carter, CV 16-80459 MARRA (SD Florida). Mahaffey and Brimer will jointly receive $1.3 million as their share of the settlement.
Concurrent with the settlement announced today, Carter Healthcare has agreed to pay an additional $22,948,004.54 to resolve another who there labeled action US ex rel. Duffield et al. v. CHC Holdings, LLC, et al.Case No. 17-CV-826-HE (WD Okla.), filed in the Western District of Oklahoma, alleging that Carter Healthcare improperly paid remuneration to its Oklahoma and Texas home health medical directors to induce referrals of Medicare and TRICARE home health patients between 2013 and 2020.
The government’s decision on this issue illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services (HHS) at 800-HHS-TIPS (800-447-8477).
The United States investigation into this matter was led by the Commercial Disputes Division of the Civil Division, the Office of the United States Attorney for the Southern District of Florida, and the Office of Inspector General of the United States Department of Health and Human Services.
Trial Attorney Gregory Mason of the Civil Division’s Fraud Unit and Assistant U.S. Attorneys James A. Winkle and John Spacarotella for the Southern District of Florida handled the matter.
The claims resolved by the settlement are allegations only and no liability has been established.