On August 4, the U.S. Department of Justice (DOJ) announced that it had reached a "first of
its kind" Settlement Agreement with Pediatric Services
of America Healthcare and its affiliates (PSA) to resolve certain
allegations that PSA violated the federal
False Claims Act (FCA) by failing to investigate and return
overpayments as required by Section 6402 of the Affordable Care
Act.
PSA owns and operates home health agencies that provide nursing
services to infirm children. The DOJ alleged that PSA knowingly (1)
failed to disclose and return overpayments that it received from
the Medicare, Medicaid and TRICARE programs; (2) submitted claims
under the Georgia Pediatric Program that were not reimbursable due
to PSA's failure to properly document supervisory visits; and
(3) submitted claims to various state and federal healthcare
programs that overstated the length of time care was provided,
resulting in overpayments to PSA. The allegations against PSA were
initially filed by two former employees under the FCA's qui tam
(whistleblower) provisions, which generally permit individuals to
initiate actions on behalf of the United States alleging violations
of the FCA.
As part of the Settlement Agreement, PSA agreed to pay
approximately $6.9 million to resolve the allegations, of which
approximately $4.2 million will be paid to the United States and
approximately $2.7 million will be shared by the states
participating in the action. As qui tam relators, the two former
employees are entitled to share in a portion of the recovery paid
to the United States. The Settlement Agreement is neither an
admission of liability by PSA nor a concession by the United States
that the allegations against PSA were unfounded.
In addition to the Settlement Agreement, PSA agreed to enter into a
Corporate Integrity Agreement (CIA) with the Office of Inspector
General of the U.S. Department of Health and Human Services. Under
the CIA, PSA will be required to, among other things, develop,
implement and monitor policies and procedures to prevent the
conduct that gave rise to the allegations of violating the FCA.
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