Nationwide Home Healthcare and Hospice Provider to Pay $3.85M to Resolve False Claims Act Allegations

 

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.

Bronx Borough President Vanessa L. Gibson - Community Resources & Updates

 

Dear Neighbor,

 

Thank you for joining us for another week in review.

Last week, the City Council voted in support of the Bronx Metro-North Area Plan, paving the way for the development of approximately 7,000 new homes in our borough and transformative changes to the East Bronx. This comprehensive approach to development reflects our shared commitment to building a stronger, more resilient Bronx that addresses our housing shortage and increases homeownership opportunities for our residents. I want to thank the New York City Council, Mayor Eric Adams, the New York City Department of City Planning, as well as our East Bronx residents, Community Boards, and other pertinent stakeholders whose voices were essential to moving this plan forward. We look forward to seeing the implementation of this great plan. 

Also, a big thank you to everyone who came out to our Health Bucks Pop-Up at BronxWorks Farmstand last Thursday. Your participation in promoting healthy living is what makes our borough thrive. Keep an eye out across our social media platforms for upcoming pop-up locations near you!

Lastly, we’re excited to invite you to the next installment of our Bronx Summer Concert Series, celebrating Ecuadorian Heritage Month at Ferry Point Park on Sunday, August 25th! Join us for an afternoon filled with vibrant music, dance, and cultural festivities that honor the rich traditions of the Ecuadorian community.

If you have any questions or concerns, please do not hesitate to contact our office at 718-590-3500 or email us at webmail@bronxbp.nyc.gov.

In partnership,

Bronx Borough President Vanessa L. Gibson.

IN THE COMMUNITY

Our team hosted our first Farmers Market Pop-Up in partnership with Bronx Works at the Bronx Works Farm Stand on 1130 Grand Concourse today!

We were thrilled to distribute Health Bucks and share valuable resources to promote nutrition and healthy eating as part of our effort to combat food insecurity.

Thank you to everyone who came out and supported this initiative. We can’t wait to see you at our upcoming pop-ups!

UPCOMING EVENTS

COMMUNITY EVENTS

DEC Releases Long Island Groundwater Sustainability Project Phase 1 Study Results

 

Advanced Groundwater Modeling Examined Western Long Island’s Aquifer System

The New York State Department of Environmental Conservation (DEC), in collaboration with the United States Geological Survey’s (USGS) New York Water Science Center, announced the release of the Long Island Groundwater Sustainability Project (LIGWSP), the Island-wide groundwater model, and Phase 1 study and scenario results. Phase 1 focused on the aquifer system beneath Kings, Queens, and Nassau counties and provides valuable information about how the aquifer reacts under various scenarios, including sea level rise, drought, pumping, and more.

 

“Protecting Long Island’s sole source aquifer is critical, and this comprehensive science-driven modeling is an important tool for DEC and water supply stakeholders to manage this precious water resource effectively and efficiently,” DEC Interim Commissioner Sean Mahar said. “DEC looks forward to continuing this collaborative effort with U.S. Geological Survey to identify challenges and advance actions to ensure clean drinking water supplies for the long term.”

"The results of this study will advance our scientific understanding of Long Island’s groundwater-flow system,” United States Geological Survey’s New York Water Science Center Director Robert Breault said. “Through use of this knowledge, water suppliers and policymakers can better manage the Long Island aquifer system.”

Long Island’s sole source aquifers are used to supply water to more than 2.8 million New Yorkers. Factors such as over-pumping, population increase, pollutants, and climate change can stress the aquifer system and public water supply.

 

The Long Island Groundwater Sustainability Project is a multi-phase effort initiated in 2016 to develop a comprehensive state-of-the-art 3D groundwater model to understand Long Island’s sole source aquifer, help make informed, scientifically driven water-use decisions, and bolster water supply sustainability and resiliency on Long Island. The study simulates changes in aquifer recharge, groundwater pumping, and sea-level position to determine the effects of these changes on water levels, streamflows, and saltwater intrusion from 1900 to present, and can be used to simulate the aquifer system’s response to various hydrologic stresses in the future. Phase 1 results are available on the Groundwater Sustainability of the Long Island Aquifer System webpage.

Phase 1 major findings include:

• location of the boundary between fresh and salty groundwater is most likely much closer to the coastline than previously thought;
• historical onshore saltwater intrusion in Kings and Queens counties has not receded, despite the cessation of groundwater withdrawals since the early 1990s;
• although saltwater intrusion remains a concern in certain localized areas of western Long Island, presently saltwater intrusion is not a significant concern for its overall water supply; and
• increases in aquifer recharge and sea level in response to climate change can increase water levels and stream flows, creating concerns for groundwater flooding of subterranean infrastructure in low-lying areas where the unsaturated zone is already thin.

Phase 2 of the study, which includes well drilling, data collection, and model recalibration for Suffolk County, is anticipated to be complete in 2025. Phase 3 will identify and fill data gaps identified during Phases 1 and 2 and will include long-term monitoring and modeling maintenance.

 

DEC anticipates more detailed analysis of the phase 1 scenario results and future phase 2 and 3 results will lead to more understanding of areas and issues of concern. DEC will use this tool to predict the outcomes of various water withdrawal management strategies. Based on current and future model scenario outcomes, DEC will work with partners to develop policies and best management practices to protect Long Island’s groundwater resources.

 

Visit DEC’s website for more information about the Long Island Well Program.

For Immediate Release: State Labor Department Releases Preliminary July 2024 Area Unemployment Rates

 The New York State Department of Labor today released preliminary local area unemployment rates for July 2024. Rates are calculated using methods prescribed by the U.S. Bureau of Labor Statistics. The State’s area unemployment rates rely in part on the results of the Current Population Survey, which contacts approximately 3,100 households in New York State each month. To recap last week’s statewide press release, New York State’s seasonally adjusted unemployment rate increased from 4.2% to 4.3% in July 2024.

Local Area Unemployment Rates* (%)
July 2023 and July 2024
(Not seasonally adjusted)

The data in the preceding table are not seasonally adjusted, which means they reflect seasonal influences (e.g., holiday and summer hires). Therefore, the most valid comparisons with this type of data are year-to-year comparisons of the same month, for example, July 2023 versus July 2024. Labor force data for the current month are preliminary and subject to revision as more information becomes available the following month. Revised estimates for prior months are available at: https://dol.ny.gov/local-area-unemployment-statistics Labor force statistics, including the unemployment rate, for New York and every other state are based on statistical regression models specified by the U.S. Bureau of Labor Statistics. These are the most up-to-date estimates of persons employed and unemployed by place of residence. Estimates are available for New York State, labor market regions, metropolitan areas, counties and municipalities with population of at least 25,000.

 

Unemployment Rates By County,
New York State,
July 2024

Jobs and Unemployment Fact Sheet This fact sheet conveys important technical information that will contribute to a better understanding of labor force data (“household survey”), including resident employment/unemployment rates, and jobs by industry data (“business survey”), which are presented in the New York State Department of Labor’s monthly press release. State Unemployment Rates Based on Regression Model Beginning with data for January 1996, unemployment rates for New York State and all other states (as well as New York City and the City of Los Angeles) have been estimated using time-series regression statistical models developed by the U.S. Bureau of Labor Statistics (BLS). Advantage of Regression Model Use of a time-series regression model reduces the month-to-month variation in unemployment rates and resident employment by reducing variation caused by sampling errors and other components of statistical noise (irregularities). Benchmarking of Estimates Once each year, labor force estimates, such as civilian labor force and the unemployment rate, are revised to reflect updated input data including new Census Bureau populations controls, newly revised establishment jobs data and new state-level annual average data from the Current Population Survey (CPS). As part of this procedure, all state figures are reviewed, revised as necessary and then re-estimated. This process is commonly referred to as “benchmarking.” Changes in Methodology Labor force estimates are now produced with an improved time-series regression model, which utilizes “real-time” benchmarking. “Real-time” benchmarking reduces end-of-year revisions, which also means that major economic events will be reflected in a more timely manner in state labor force estimates. In addition, the new methodology includes an updated way of estimating for sub-state areas (e.g. counties, metro areas) the number of unemployed who are new entrants or re-entrants into the labor force. This change in methodology will result in lower unemployment rates in some areas and increased rates in others. Unemployed and UI Beneficiaries The estimate of the number of unemployed includes all persons who had no employment during the reference week (the week including the 12th of the month), were available for work, except for temporary illness, and had made specific efforts to find employment sometime during the 4-week period ending with the reference week. Unemployment insurance (UI) beneficiaries include those who apply for and qualify for UI benefits. Consequently, the estimate of the number of unemployed and the number of UI beneficiaries do not necessarily move in tandem. Jobs Data Jobs data are obtained from a separate joint federal-state survey of business establishments. The survey, called the Current Employment Statistics of Establishments, samples establishments in New York State. It excludes self-employed workers, agricultural workers, unpaid family workers and domestic workers employed by private households. This data represents a count of jobs by place of work. Data for each month is revised the following month as more complete information becomes available. The New York State Department of Labor is an Equal Opportunity Employer/Program.

Owner Of Insurance Firm Sentenced To 10 Years In Prison For $40 Million Scheme To Steal Client Healthcare Funds And Defraud Lenders

 

Damian Williams, the United States Attorney for the Southern District of New York, announced today that ANTHONY RICCARDI, an owner and manager of the Connecticut insurance firm Employee Benefit Solutions LLC (“EBS”), was sentenced to 10 years in prison for conspiring to commit wire fraud and bank fraud.  Between 2015 and 2019, RICCARDI and his co-conspirators used EBS as part of a widespread, $40 million scheme to misappropriate and steal client healthcare funds and defraud multiple lenders.  RICCARDI previously pled guilty on February 21, 2023, before U.S. District Judge Philip M. Halpern, who imposed today’s sentence. 

U.S. Attorney Damian Williams said: “For years, Anthony Riccardi schemed to abuse his position of trust by stealing millions in fiduciary money that was meant to pay for important employee healthcare expenses.  He used this stolen money to fund a lavish lifestyle that included luxury cars and a sprawling mansion.  To keep the scheme going, Riccardi also defrauded lenders out of millions.  This sentence underscores that no matter how complex the scheme is, those who use their positions defraud others and enrich themselves will answer for their crimes. 

According to the Indictment, the Complaint, other court filings, and statements made during court proceedings:

From at least 2015 and continuing through 2019, RICCARDI was the 50% co-owner and Executive Vice President of EBS, which offered a variety of healthcare insurance-related services to clients.  EBS, among other things, provided third party healthcare claims administration (“TPA”) services to clients that elected to “self-fund” (or self-insure) their employee healthcare plans.  As a TPA, EBS would purportedly administer, process, and pay healthcare claims for its clients’ employees in exchange for an administrative fee.

Between at least 2015 and continuing through 2019, EBS represented an automobile dealership chain (“Company-1”) headquartered in Westchester County, New York.  EBS served as a TPA for Company-1’s self-funded employee healthcare program and purported to process and pay claims to medical providers that treated Company-1’s employees.  To do this, EBS generated bimonthly “check register” invoices for Company-1 that listed all employee healthcare expenses from healthcare providers during that two-week period.  EBS also administered a bank account on Company-1’s behalf for the express purpose of paying Company-1 healthcare claims.  Company-1 would fund each check register by paying the invoiced amount, expecting that EBS would promptly pay the claims to the healthcare providers.  During this period, Company-1 transferred approximately $26 million to EBS for the payment of healthcare claims.

In reality, a significant number of purported checks listed on the EBS “check register” invoices were never actually deposited by the healthcare providers.  Instead, approximately $17.87 million in Company-1 healthcare payments were misappropriated with the overwhelming majority simply transferred by EBS into its own operating account, where they were used for non-healthcare expenses by the managers and owners of EBS.  For example, a review of bank records indicates that Company-1 healthcare funds were used by RICCARDI and his co-conspirators to pay their home mortgage expenses as well as a personal credit card account with expenses relating to boating, luxury cars, and golf.

EBS, through RICCARDI and his co-conspirators, made decisions on what few Company-1 healthcare claims they did pay based on which healthcare providers were likely to complain if they did not receive payment or if the claims were connected to Company-1 executives.

The “check registers” sent to Company-1 also contained millions of dollars in fraudulent or inflated healthcare claims that were eventually paid by Company-1.  EBS routinely inflated the Company-1 check registers at the direction of RICCARDI and his co-conspirators.  Such efforts were typically accomplished through RICCARDI and his co-conspirators instructing others to manually create fraudulent entries in the EBS claims processing software, including fake claims under the name of a business controlled by RICCARDI.  RICCARDI and his co-conspirators also took steps to conceal their fraud from Company-1 by creating and sending manipulated and fabricated bank statements and checks to create the appearance that healthcare claims were being paid by EBS, when in reality, they were not.   

By mid-2017, as EBS buckled under mounting outstanding fiduciary obligations, RICCARDI and his co-conspirators began an elaborate effort to conceal and perpetuate the ongoing fraud on Company-1 by applying for multiple fraudulent bank loans and merchant cash advances designed in part to pay various fiduciary obligations that EBS owed to Company-1.  RICCARDI and his co-conspirators fraudulently applied for and received millions of dollars in loans under the auspices of financing the purchase of upgraded billing software for EBS, which included RICCARDI and his co-conspirators submitting fabricated invoices from a fake company that supposedly sold the billing software.

In addition to the prison term, RICCARDI, 46, of New Canaan, Connecticut, was sentenced to three years of supervised release.  He was additionally ordered to pay $14,870,653.36 in restitution and forfeit $2,000,000.00.

RICCARDI’s co-defendant, Patricia Riccardi, was previously sentenced to 30 months in prison following her guilty plea to one count of conspiring to commit wire fraud and bank fraud before Judge Halpern.

RICCARDI’s co-conspirator, Erin Verespy, was previously sentenced to 66 months in prison following her guilty plea to one count of conspiring to commit wire fraud and bank fraud before U.S. District Judge Cathy Seibel.

Mr. Williams praised the outstanding investigative work of the U.S. Postal Inspection Service and the Special Agents of the U.S. Attorney’s Office.  Mr. Williams also thanked the U.S. Department of Labor, Employee Benefits Security Administration; the U.S. Department of Labor, Office of Inspector General; and the U.S. Secret Service, which are assisting in the investigation, as well as the U.S. Attorney’s Office for the District of Connecticut.

The prosecution is being handled by the Office’s White Plains Division.  Assistant U.S. Attorney Nicholas S. Bradley is in charge of the prosecution.

NYC PUBLIC ADVOCATE'S STATEMENT ON THE FIFTH DEATH IN CITY CUSTODY THIS YEAR

"Another New Yorker lost their life in city custody today, the fifth of the year and 33rd under this administration. This is the status quo on Rikers. The mayor was so desperate to preserve that he refused to enforce the law banning solitary and the use of prolonged isolation, declaring a state of emergency to block it. There has long been a crisis on Rikers, as today’s tragic loss shows, but the administration is relying on keeping that emergency in place, rather than acting to address it.”