PruittHealth, Inc., the metro Atlanta-based nursing home giant, will pay $4.2 million to resolve a federal case alleging that it billed Medicare and Medicaid for home health services that weren’t eligible for reimbursement.
The settlement, which stemmed from a whistleblower lawsuit brought by a former employee, was announced on Monday by the U.S. Justice Department as part of an investigation that dates back to claims PruittHealth submitted to the federally funded health care programs in 2011 and 2012.
The lawsuit alleged that the company had submitted hundreds of claims for services that were not covered by the programs because no physician had certified that patients required home health services.
“Healthcare providers must not place their own financial well-being ahead of their duties under the Medicare and Medicaid programs,” said U.S. Attorney Kurt R. Erskine, who serves Atlanta and the Northern District of Georgia.
When the company learned about the overpayments, it didn’t disclose their receipt, according to the Justice Department’s release announcing the settlement.
“When funds from programs like Medicare and Medicaid are not used as intended, taxpayers and people entitled to those funds suffer,” said Chris Hacker, Special Agent in Charge of the FBI’s Atlanta office.
The government said the company’s efforts to improve compliance for its home health program factored into the Justice Department’s decision on the settlement. The company enlisted a consultant in 2013 to audit its home health business and has been conducting quarterly audits ever since to ensure its home health claims meet the requirements.
PruittHealth, in a statement issued Monday, said it had resolved the DOJ matter “involving Medicare paperwork” and said the services provided were medically necessary and the quality of service was never an issue. The company noted the agreement recognized the compliance efforts it had taken, including the outside consulting firm enlisted to conduct audits.
“For more than 50 years, my family has worked to elevate the level of care provided in the profession and we’ve upheld this reputation through our transparency and compliance,” Neil L. Pruitt, CEO and chairman of PruittHealth, said. “That’s why we took action when we recognized, independent of this investigation, there was opportunity for improvement at select home health locations.”
The Justice Department announcement noted that the claims in its case were “allegations only” and there had been “no determination of liability.”
Under the False Claims Act, the whistleblower, Tina Peery, will receive more than $700,000 from the settlement, which allows private citizens to bring allegations of false claims on behalf of the federal government, according to the Justice Department news release. Peery worked for the company in 2012 and 2013 as a regional administrator in its home health business in the metro area, according to her LinkedIn page. Her lawsuit, filed in 2014 but sealed until last week, states that she was fired after complaining that the company needed to repay the Medicare and Medicaid money.
She did not immediately respond to a request for comment.
The company, best known for operating some 170 nursing homes communities across Georgia and the Southeast, is the 14th largest nursing home operator in the country, according to its LinkedIn page. In recent years, the company has been rapidly expanding its home health business as that has become an attractive option for many seniors who wish to remain in their homes. That trend accelerated during the COVID-19 pandemic as nursing homes were hit hard.
The company for years has been headquartered in Norcross. In August, the company received approval from the Chamblee Downtown Development Authority to receive a $6 million tax abatement as part of a plan relocate nearly 530 employees to its new corporate headquarters in that city.
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