Corporate Compliance

Government unseals whistleblower fraud suits against Louisville firm

Compliance Monitor, April 27, 2005

The federal government unsealed three whistleblower suits against Louisville, KY-based HealthEssentials Solutions just a few weeks after the provider filed for bankruptcy, reported The Courier-Journal of Louisville, KY, on April 20.

The suits allege that the company billed Medicare for more expensive services than its nurse practitioners performed, The Courier-Journal reported. One of the suits claims that HealthEssentials Solutions billed Medicare for house calls when in fact staff visited patients at assisted-living facilities. Medicare reimburses at a higher rate for house calls. Two former employees filed this particular suit, claiming that they had documented more than $2 million in overbilling since 2000.

Two other lawsuits allege that the company engaged in other unspecified upcoding to receive reimbursement to which it wasn't entitled, The Courier-Journal reported. If the company is found guilty, the whistleblowers filing the corresponding suits will be entitled to 15% to 30% of any funds the government recovers.

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