Murphy Anderson lawyers represent Ohio whistleblower in Medicaid home healthcare company fraud settlement

March 11, 2022

Academy Health Services Inc., an Ohio in-home nursing healthcare provider, agreed to pay $500,000 to the government and cease operations as part of a settlement of a False Claims Act case brought by a Murphy Anderson client.

The Academy whistleblower, a licensed practical nurse and former Academy employee, filed a qui tam whistleblower lawsuit against Academy in 2015, alleging that it fraudulently billed Medicaid for individual visits to patients with intellectual disabilities, when the visits actually occurred in group settings. Home healthcare individual service visits are reimbursed by Ohio Medicaid at a 25% higher rate than group visits. Academy allegedly billed for individual visits regardless of the patient’s actual group home living situation, defrauding Medicaid.

Murphy Anderson attorney Ann Lugbill, who represented the whistleblower, praised the government for reaching a settlement that required Academy to close its business entirely as well as requiring its owners to pay the federal and state governments for the alleged fraud. “This is not a ‘slap on the wrist’ settlement. Much of the value to the taxpayers in this settlement is not just money paid in settlement, but the fact that funds will not be wasted in the future. Now, hopefully, patients can get better care from honest home healthcare provider agencies.”

The whistleblower’s lawsuit states that most Academy patients with developmental disabilities that he cared for lived in group homes. However, Academy’s false claims submitted to Medicaid falsely represented that the patients lived alone and not in group homes.

In a statement, the U.S. Attorney’s Office for the Southern District of Ohio observed that “Academy nurses did not spend the time required with patients to receive reimbursement for individual services.”

The whistleblower’s lawsuit alleged that Academy violated the federal Medicare and Medicaid Anti-Kickback Statute by paying for patients’ “spend down” amounts, the minimum amount of medical expenses that patients must incur to qualify for Medicaid if their incomes are otherwise too high. By allegedly paying patients’ spend-down amounts, Academy could maximize its reimbursement from the government by keeping patients on Medicaid who otherwise would not qualify.

In addition to Ann Lugbill and Mark Hanna of Murphy Anderson PLLC, the Ohio nurse whistleblower  is represented by Neil Klingshirn of Employment Law Partners, LLC.

If you have knowledge of Medicaid or other healthcare-related fraud, you can contact Murphy Anderson lawyers for a free consultation. Murphy Anderson attorneys have decades of experience in successfully representing False Claims Act qui tam whistleblowers in healthcare fraud cases.

Read the Justice Department’s press release.

Read the whistleblower’s qui tam complaint.