Traditions Health LLC (Traditions) has agreed to pay $34 million to resolve its civil liability under the False Claims Act for billing medically unnecessary home health claims to Medicare and providing financial benefits to physicians in exchange for referrals. Traditions self-disclosed the conduct at issue to the government.
The settlement resolves allegations that, from 2021 to 2024, Traditions submitted claims to Medicare from its McAlester, Oklahoma, location for home health services that were not medically necessary. It also resolves claims that, between 2019 and 2024, Traditions paid remuneration to physician-medical directors in Oklahoma and Texas who referred Medicare beneficiaries to Traditions for home health services and that this remuneration potentially violated the Anti-Kickback Statute and the Physician Self-Referral Law.
The Anti-Kickback Statute prohibits the provision of remuneration to induce referrals of government health care program business. The Physician Self-Referral Law, commonly known as the Stark Law, prohibits physicians from making referrals for the furnishing of certain designated health services, including home health, payable by Medicare to an entity where the physician has a “financial relationship,” unless the arrangement meets the requirements of a statutory or regulatory exception. Federal law prohibits payment by federal health care programs of medical claims that result from arrangements that violate the Anti-Kickback Statute or the Stark Law.
In connection with its self-disclosure, Traditions took a number of significant steps entitling it to credit for cooperating with the government. Following its independent investigation, Traditions provided detailed and thorough written disclosures to the government and cooperated with the government throughout the investigation. Traditions also promptly took remedial actions including removing individuals identified as responsible for the misconduct, improving its compliance program, and providing additional training to its employees.
“Home health care is critical to Medicare patients who are unable to leave their homes for treatment,” said Deputy Assistant Attorney General Brenna E. Jenny of the Justice Department’s Civil Division. “As today’s settlement reflects, when health care providers fail to uphold the rules of the Medicare program, they can mitigate the consequences by making timely self-disclosures, cooperating with the government’s investigation, and promptly taking appropriate remedial measures.”
“Billing and receiving payments from Medicare for unnecessary and inappropriate medical care is a practice which cannot and will not be tolerated,” said U.S. Attorney Christopher J. Wilson for the Eastern District of Oklahoma. “The disclosure and settlement agreed to by Traditions Health LLC in this case demonstrates that early mitigation goes a long way towards addressing fraud and mitigating the loss of taxpayer dollars.”
“Preying on vulnerable patients for financial gain is unacceptable,” said Acting Deputy Inspector General for Investigations Scott J. Lampert at the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “Providers who engage in kickbacks and false claims will be held accountable. This resolution reinforces OIG’s commitment to protecting patients, preserving program integrity, and safeguarding taxpayer dollars.”
The resolution obtained in this matter 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 Eastern District of Oklahoma, and HHS-OIG.
The investigation and resolution of this matter 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).
Fraud Section Trial Attorney Jonathan Hoerner and Assistant U.S. Attorney Joshua Mitts for the Eastern District of Oklahoma handled this matter.
The claims resolved by the settlement are allegations only and there has been no determination of liability.