Intrepid U.S.A. Inc., headquartered in Dallas, and various wholly-owned subsidiaries (Intrepid) have agreed to pay $3,850,000 to resolve allegations that Intrepid violated the False Claims Act in connection with two lines of its business: first, that Intrepid knowingly submitted claims to Medicare for home healthcare services for patients who did not qualify for the Medicare home healthcare benefit or where services otherwise did not qualify for Medicare reimbursement; and second, that Intrepid knowingly submitted claims to Medicare for patients who did not qualify for the hospice benefit. The settlement is based on Intrepid’s ability to pay.
The United States alleged that, between 2016 and 2021, 19 Intrepid home healthcare facilities submitted claims to Medicare for home healthcare services for patients who did not qualify or were not properly certified as eligible for the Medicare home healthcare benefit, where the services provided were not reasonable or medically necessary, where the services were provided by untrained staff, or where services were not performed. Separately, the United States alleged that, between 2016 and 2021, three Intrepid hospice facilities admitted patients to hospice care who were ineligible for the Medicare hospice benefit because they were not terminally ill or continued providing services to patients who should have been discharged because they no longer met the requirements for the Medicare hospice benefit.
“Medicare’s hospice and home healthcare benefits provide critical services to vulnerable patient populations across the country,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “This settlement reflects our commitment to ensuring that these benefits are used to care for those who need them and not just to enrich those who seek to provide them.”
“The Medicare Program provides vital health insurance to the elderly and disabled population,” said U.S. Attorney Michael A. Bennett for the Western District of Kentucky. “Our office will vigorously pursue unscrupulous providers who choose to illegally and improperly bill the Medicare Program.”
“Businesses who engage in improper Medicare billing practices undercut the legitimate provision of healthcare services for patients in need,” said U.S. Attorney Andrew Luger for the District of Minnesota. “This settlement reinforces the importance of holding accountable health care providers who seek financial gain above quality patient care.”
“Home health is designed to increase health care access for our most vulnerable populations with mobility limitations, while hospice care aims to provide comfort and relief for the terminally ill. Exploiting these systems for financial gain is intolerable,” said Special Agent in Charge Tamala E. Miles of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Working with our law enforcement partners, we will continue to pursue health care providers who jeopardize the integrity of these services by prioritizing profit over medically necessary palliative care.”
The civil settlement resolves claims brought under the qui tam or whistleblower provisions of the False Claims Act in two different lawsuits. One qui tam action was brought by Jennifer Jones, a former travel nurse, and Pamela Joffe, a former Director of Quality Assessment Performance Improvement and New Business Development, for Intrepid. The qui tam case is captioned U.S. ex rel. Jones v. Intrepid USA Healthcare Inc., No. 19-sc-2973 (D. Minn.). The second qui tam action was brought by Marsha Rigney, a former Director of Clinical Excellence and Integrity, and Janet Watts, a former Regional Manager of Clinical Excellence, for Intrepid. This qui tam case is captioned U.S. ex rel. Rigney v. Intrepid U.S.A. Inc., No. 3:20-cv-95-RGJ (WDKY). Under the provisions of the False Claims Act, a private party can file an action on behalf of the United States and receive a portion of any recovery. Relators Jones and Joffe will receive $333,985 from the settlement proceeds, and Relators Rigney and Watts will receive $359,014 from the settlement proceeds.
The resolution of these matters was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the U.S. Attorney’s Office for the Western District of Kentucky and U.S. Attorney’s Office for the District of Minnesota. HHS-OIG assisted in the investigations.
The investigation and resolution of these matters illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to HHS at 800-HHS-TIPS (800-447-8477).
The claims resolved by the settlement are allegations only. There has been no determination of liability.
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