The feds have accused the home-based healthcare services providers of billing for laboratory and diagnostic testing from 2010 through 2015 that was not reasonable or necessary for the diagnosis or treatment of an illness or injury. As a result, the government argues that these payments were overpayments and has demanded repayment.
How does the government build these cases?
In this particular example, five different individuals who worked with the home-based healthcare services providers filed whistle-blower lawsuits. This triggered an investigation which led to the demand for repayment.
What happens if a healthcare provider does not pay back the money?
The government could decide not to pay out future claims. This can have a huge impact on any healthcare business’ bottom line as the United States Centers for Medicare and Medicaid Services estimates that over 62.6 million people in the United States are enrolled in Medicare. This translates to approximately 20% of the population.
What if we chose to fight back?
There are options to contest the government’s demand that you repay an alleged Medicare overpayment. The appeals process has five different levels, allowing multiple opportunities to push back against the government’s claims.
What happened in the case discussed above?
After reviewing the allegations and evidence, the home-based healthcare services providers agreed to pay $8.5 million to settle the claims. It is important to note the whistleblower lawsuits mentioned above also contained allegations of False Claims Act violations. Due to a remedy provision within the FCA, the remedies provided through the overpayment demand satisfy those claims while also resolving the FCA allegations.
Attorney John Rivas is responsible for this communication