Date: 05-11-2022

Case Style: United States of America v. SHC Home Health Services of Florida, L.L.C.

Case Number: K. Michael Moore

Judge: 1:15-cv-24713-KMM

Court: United States District Court for the Southern District of Florida (Miami-Dade County)

Plaintiff's Attorney: United States Attorney’s Office and Daniel Calabro, Natalie Khawam

Defendant's Attorney: No Appearance

Description: Miami, Florida qui tam lawyers represented the United States, which sued SHC Home Health Services-Ocala, LLC., et al. on a False Claims Act whistleblower theory claiming Defendant improperly billing the Medicare Program for home health services provided to beneficiaries living in Florida.

Signature HomeNow operated home healthcare services in Florida and its corporate headquarters are located in Louisville, Kentucky.

According to a complaint filed in the United States District Court for the Southern District of Florida against Signature HomeNow and the subsequent settlement agreement, it was alleged that between 2013 and 2017 Signature HomeNow knowingly submitted false or fraudulent claims seeking payment from the Medicare Program for home health services to Medicare beneficiaries who: (i) were not homebound; (ii) did not require certain skilled care; (iii) did not have a valid or otherwise appropriate plans of care in place; and/or (iv) did not have appropriate face-to-face encounters needed in order to be appropriately certified to receive home health services.

This matter arose from a complaint to the Department of Health and Human Services, Office of Inspector General (HHS-OIG) complaint hotline (https://oig.hhs.gov/fraud/report-fraud/) and from a complaint for monetary damages under the qui tam provisions of the federal False Claims Act. See United States ex rel. Barbara Mellott-Yezman and Patricia Rench v. SHC Home Health Services-Ocala, LLC et al., Case No. 15-cv-24713 (S.D. Fla.).

“The fraudulent billing of Medicare will not be tolerated,” said Juan Antonio Gonzalez, U.S. Attorney for the Southern District of Florida. “We will continue to aggressively pursue cases against those who erode the fabric of our federal health care programs by submitting false claims to Medicare.”

“Overbilling Medicare by submitting false claims increases the cost of medical care for all and undermines the integrity of the Medicare program,” said Michael A. Bennett, U.S. Attorney for the Western District of Kentucky. “This office will continue to vigorously pursue unscrupulous health care providers who attempt to defraud the Medicare program.”

“When health care companies try to boost their profits by fraudulently billing federal health care programs, our agency will work closely with our law enforcement partners to hold them accountable for their schemes,” said HHS-OIG Atlanta Regional Office Special Agent in Charge Miles.

HHS-OIG Atlanta Regional Office investigated the case, with assistance from HHS-OIG Miami. Assistant U.S. Attorneys James A. Weinkle and John Spaccarotella (of the U.S. Attorney’s Office for the Southern District of Florida), Assistant United States Attorneys Benjamin S. Schecter, Jessica R.C. Malloy, and Matt Weyand (of the U.S. Attorney’s Office for the Western District of Kentucky) handled the litigation.

Title 31 U.S.C. 3729 provides:

a) Liability for Certain Acts.—

(1) In general.—Subject to paragraph (2), any person who—

(A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;

(B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim;

(C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);

(D) has possession, custody, or control of property or money used, or to be used, by the Government and knowingly delivers, or causes to be delivered, less than all of that money or property;

(E) is authorized to make or deliver a document certifying receipt of property used, or to be used, by the Government and, intending to defraud the Government, makes or delivers the receipt without completely knowing that the information on the receipt is true;

(F) knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer or employee of the Government, or a member of the Armed Forces, who lawfully may not sell or pledge property; or

(G) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government,

is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note; Public Law 104–410 1), plus 3 times the amount of damages which the Government sustains because of the act of that person.

(2) Reduced damages.—If the court finds that—

(A) the person committing the violation of this subsection furnished officials of the United States responsible for investigating false claims violations with all information known to such person about the violation within 30 days after the date on which the defendant first obtained the information;

(B) such person fully cooperated with any Government investigation of such violation; and

(C) at the time such person furnished the United States with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under this title with respect to such violation, and the person did not have actual knowledge of the existence of an investigation into such violation,

the court may assess not less than 2 times the amount of damages which the Government sustains because of the act of that person.

(3) Costs of civil actions.—A person violating this subsection shall also be liable to the United States Government for the costs of a civil action brought to recover any such penalty or damages.

(b) Definitions.—For purposes of this section—

(1) the terms “knowing” and “knowingly”—

(A) mean that a person, with respect to information—

(i) has actual knowledge of the information;

(ii) acts in deliberate ignorance of the truth or falsity of the information; or

(iii) acts in reckless disregard of the truth or falsity of the information; and

(B) require no proof of specific intent to defraud;

(2) the term “claim”—

(A) means any request or demand, whether under a contract or otherwise, for money or property and whether or not the United States has title to the money or property, that—

(i) is presented to an officer, employee, or agent of the United States; or

(ii) is made to a contractor, grantee, or other recipient, if the money or property is to be spent or used on the Government's behalf or to advance a Government program or interest, and if the United States Government—

(I) provides or has provided any portion of the money or property requested or demanded; or

(II) will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded; and

(B) does not include requests or demands for money or property that the Government has paid to an individual as compensation for Federal employment or as an income subsidy with no restrictions on that individual's use of the money or property;

(3) the term “obligation” means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee-based or similar relationship, from statute or regulation, or from the retention of any overpayment; and

(4) the term “material” means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.

(c) Exemption From Disclosure.—Any information furnished pursuant to subsection (a)(2) shall be exempt from disclosure under section 552 of title 5.

(d) Exclusion.—This section does not apply to claims, records, or statements made under the Internal Revenue Code of 1986.

Outcome: Settled for $2.1 million.

Plaintiff's Experts:

Defendant's Experts:

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