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Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

It’s one thing to cause taxpayers to pay for services not covered by Medicare; it’s entirely something else for medical providers to visit homebound patients just so they can bill the government for medically unnecessary services. (That’s just wrong.) Today’s “Fraud of the Day” article explains how a medical home health company and its managed services firm recently resolved allegations that the two companies “routinely” filed false Medicare claims.

The medical home health company at the center of today’s case provides physician services for elderly patients as well as other adults across twelve states. The other firm provides management services for the physicians, including billing services.

The government alleges that the providers employed by the medical home health company carried out many patient visits that were not medically necessary. (Then, the managed services company stuck Medicare with the bill.) The government healthcare program contends that the two companies pocketed more than $800,000 just in the State of Wisconsin between 2013 and 2016 for unnecessary services.

Under the settlement, the two companies will repay more than $800,000 the federal government says it illegally received from the Medicare program. (Fair enough. No jail time needed. Perhaps investigators should look into these companies and their billing practices across the other 11 states where they operate just to make sure there’s no funny business going on.)

Today’s Fraud of the Day comes from the U.S. Department of Justice press release, “Physician Group and Related Company Agree to Repay Over $800,000 to Medicare for Unnecessary Services,” released Dec. 20, 2019.

United States Attorney Matthew D. Krueger announced today that VPA, P.C. (VPA), and its management services affiliate, U.S. Medical Management (USMM), have agreed to pay $829,611 to the United States to resolve allegations that VPA and USMM billed Medicare for unnecessary physician visits.

VPA provides physician services for the elderly and other adults at their residences in twelve states, including Wisconsin. USMM provides management services for VPA, including billing services. The United States alleges that VPA and USMM routinely caused VPA’s physicians to conduct patient visits that were not medically necessary and then billed Medicare (through USMM) for those unnecessary visits. The government contends that VPA and USMM thus obtained over $800,000 from Medicare to which they were not entitled. The visits at issue occurred in Wisconsin from January 1, 2013 through March 31, 2016.  VPA and USMM have agreed to repay Medicare for these visits.

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