Pruitt Healthcare to Pay $4.2M to Settle False Claim Allegations
PruittHealth, Inc. and affiliated entities have agreed to pay $4.2 million to resolve allegations that they submitted claims for home health services that were not covered by the Medicare and Medicaid programs, and that they failed to refund over payments that they had received from Medicare and Medicaid in a timely manner.
Pruitt Healthcare is based in Atlanta but has offices in Toccoa and healthcare facilities in Toccoa and across North Georgia.
According to the U.S. Department of Justice, Northern District of Georgia, the Government alleges that from January 1, 2011 through June 30, 2012, Pruitt knowingly submitted claims to Medicare and Medicaid for home health services that were not eligible for reimbursement because, among other things, they did not have the required face-to-face certifications or plans of care, and they did not document the beneficiary’s homebound status or need for the home health services.
The Department of Justice further alleges that Pruitt learned that it had received payments for home health services to which it was not entitled, but failed to disclose its receipt of the overpayments, or refund the overpayments to Medicare and Medicaid in a timely manner.
“The Medicare and Medicaid programs depend on providers to submit only those claims that are eligible for reimbursement and to promptly notify the programs if they receive payments to which they are not entitled,” said U.S. Attorney Kurt R. Erskine. “Healthcare providers must not place their own financial well-being ahead of their duties under the Medicare and Medicaid programs.”
“When health care entities seek to boost their profits through improper billing, they undermine the trust taxpayers extend to the health care industry,” said Special Agent in Charge Derrick L. Jackson. “This settlement demonstrates the commitment that our agency and its law enforcement partners have to pursuing those who seek to improperly enrich themselves at the expense of federal health care programs.”
“When funds from programs like Medicare and Medicaid are not used as intended, taxpayers and people who are entitled to those funds suffer,” said Chris Hacker, Special Agent in Charge of FBI Atlanta. “This settlement is the result of the FBI’s commitment to work with our federal and state partners to ensure that federally funded healthcare programs are not abused by providers.”
In a statement to Georgia Health News, PruittHealth CEO Neil L. Pruitt said Monday that the home health services were medically necessary and actually provided, and the quality of services was never at issue.
“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,” Pruitt said in a statement Monday
“That’s why we took action when we recognized, independent of this investigation, there was an opportunity for improvement at select home health locations. We’ve gone to great lengths to ensure transparency and compliance.”
In reaching its settlement with Pruitt, the federal government took into account documents produced by the company indicating that it subsequently took steps to improve compliance with the home health requirements of the Medicare and Medicaid programs.
These actions included the retention of an outside consultant in January 2013 to conduct an audit of its home health claims. Pruitt also created a system of audits to ensure accurate billing.
This settlement resolves a lawsuit originally filed in the U.S. District Court for the Northern District of Georgia by Tina Peery under the whistleblower provisions of the False Claims Act.
Peery will receive over $700,000.00 from the settlement.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.