PruittHealth to pay $4.2 million in false claims case

A recent report in the Atlanta Journal Constitution reports that PruittHealth will pay $4.2 million in false claims case.

PruittHealth, Inc., the metro Atlanta-based nursing home giant, will pay to resolve a federal case alleging that it billed Medicare and Medicaid for home health services that weren’t eligible for reimbursement.

In the AJC’s article it explains that the settlement 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.

The AJC’s article states that when the company learned about the overpayments, it didn’t disclose their receipt, according to the Justice Department’s release announcing the settlement.

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.

The Justice Department announcement noted that the claims in its case were “allegations only” and there had been “no determination of liability.”

PruittHealth, best known for operating some 170 nursing homes communities across Georgia and the Southeast, is the 14th largest nursing home operator in the country, and has a location here in Toccoa-Stephens County.

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.