Intrepid USA, along with several whole-owned subsidiaries, recently reached a $3.85 million settlement with the United States Department of Justice (DOJ) to resolve allegations that the nationwide home healthcare and hospice provider violated the False Claims Act (FCA) in connection with two lines of its business. Intrepid provides home health and hospice care services to Medicare beneficiaries in multiple states, including Minnesota, Kentucky, Texas, Indiana, Georgia, and South Carolina.
According to the government, between 2016 and 2021, Intrepid home health care facilities submitted claims to Medicare for home health 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.
Additionally, the government alleged that during the same time period, three Intrepid hospice facilities admitted patients to hospice care that were ineligible for the Medicare hospice benefit because they did not have a medical prognosis for life expectance of six months or less if the patients’ illness ran its normal course, or continued to provide services to patients who should have been discharged because they no longer met the requirements for the Medicare hospice benefit.
The claims were initially brought under the qui tam provisions of the FCA in two different lawsuits. The first was brought by two individuals: a former travel nurse and Intrepid’s former Director of Quality Assessment Performance Improvement and New Business Development. The second lawsuit was also brought by two individuals, both formerly employed by Intrepid: a former Director of Clinical Excellence and Integrity and a former Regional Manager of Clinical Excellence. Relators from the first case will receive $333,985 from the settlement while the relators in the second case will receive $359,014.
“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.”
Of note, the settlement is neither an admission of liability by Intrepid nor a concession by the United States that its claims are not well-founded. Intrepid denies the allegations put forth by the United States and denies allegations in state civil actions filed in Minnesota and Kentucky.