U.S. Attorney’s Office Resolves False Claims Act Investigation

United States Attorney’s Office Resolves False Claims Act Investigation into Improper Submission of Federal Health Care Claims by Health Care & Rehabilitation Services of Southeastern Vermont

(STL.News) The Office of the United States Attorney for the District of Vermont announced that it has resolved its investigation into whether Health Care & Rehabilitation Services of Southeastern Vermont (“HCRS”) failed to screen its employees and improperly submitted to the government claims for services provided by an individual barred from receiving payments from federally funded health care programs.

“It is imperative that organizations such as HCRS that provide important mental health, substance abuse, and developmental services to Vermonters, carefully vet their employees to ensure that all requirements are followed and taxpayer money is not paid out improperly,” said Acting U.S. Attorney Jonathan A. Ophardt.  “I commend HCRS for bringing this issue to the government’s attention and committing to make changes to the ways in which it screens prospective and current employees so that it does not happen again.”

As a health care entity submitting claims to federally-funded health care programs, HCRS must ensure that its employees are not included on the exclusion list created and maintained by the Office of Inspector General of the Department of Health and Human Services (“OIG-HHS”).  OIG-HHS may exclude individuals and entities from participation in these programs for a variety of reasons, including but not limited to fraud.  For a period of nearly 10 years, HCRS employed an excluded individual and submitted claims on the person’s behalf for reimbursement to Medicare, Medicaid, and Tricare, thereby violating the federal False Claims Act.  In addition, the Medicaid Fraud and Residential Abuse Unit of the Vermont Attorney General’s Office (“MFRAU”) concluded that HCRS also violated the Vermont False Claims Act.

To resolve the claims against it, HCRS has agreed to pay to the United States and State of Vermont a total of $170,037.76 and already has begun the payment process.  The settlement amount reflects a cooperation credit in light of HCRS’s self-disclosure of the violation, assistance with the investigation, and voluntary adoption of remedial measures to guard against improper employment and claim submission in the future.

Assistant United States Attorney Lauren Almquist Lively handled this matter for the United States Attorney’s Office for the District of Vermont, in partnership with Assistant Attorney General Elizabeth L. Anderson, Director of MFRAU.  Anne E. Cramer and Kevin M. Henry of Primmer Piper Eggleston & Cramer PC represented HCRS.

SOURCE: USDOJ.Today

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