The Law Office of Tully & Weiss wants to speak with insiders who work or once worked at ResCare (also known as Res-Care, Inc). We are investigating claims of Medicare and Medicaid fraud.
Under the federal False Claims Act and the laws of dozens of states, people with inside information who are brave enough to step forward and disclose what they know about healthcare fraud involving government funded healthcare (Medicaid, Medicare & TriCare) can help save taxpayers their hard-earned money and may be eligible for large cash awards.
In California, insiders with information about fraud involving Medi-Cal may be eligible for awards from the California False Claims Act.
Who Is ResCare (Res-Care)?
ResCare bills itself as “the largest diversified health and human services provider in the U.S.” Their website says they are also:
- The biggest provider of healthcare services to people with disabilities,
- The biggest privately-owned home care company,
- The biggest community provider of high-acuity neuro-rehab, and
- “The largest career center workforce contractor in the U.S.”
Before being taken over by a private equity firm five years ago, ResCare annual reports were filed with the SEC and public. In its 2012 annual report, the company claimed that it provided services to 61,000 people per day in 44 states plus Washington DC and Puerto Rico. That report also claimed the company employed 46,000 people.
Much of the community and in home services provided by Res Care include professional nursing, personal care, Alzheimer’s care, dementia care, homemaking and companionship. Services are offered in patients’ homes, nursing facilities, assisted living facilities and even hospitals. Services may just be for 1 or 2 hours per week or for patients with more needs, up to 24 hours per day. Home care is offered in 34 states (as of December 31, 2012).
In some states, Res-Care provides telemedicine services and emergency call button response.
Investigation into ResCare’s Billing Practices (Possible Medicaid Fraud)
We are investigating claims that Res-Care does not properly bill for home and community based attendant services.
Patients receiving home care services through Medicaid (Medi-Cal) must have those services approved by a physician. Thereafter, those services must be recertified every year and revaluations done every 6 months.
The purpose of the annual certification process is to ensure that patients require the services they are receiving and to see if the patients may require additional or different services. As patients recover or as their conditions worsen, their needs change.
Medicaid doesn’t want to pay for services that are not medically necessary. When Medicaid overpays, taxpayers pick up the tab. Because there are often wait lists for certain services, providers that falsely certify or fail to properly certify home care visits may be causing truly needy patients to go without needed care.
Recertification visits generally must be done in the patient’s home or wherever the patient is receiving care. The process is quite involved and requires an experienced nurse supervisor to review patients’ records, patient concerns and progress notes.
That supervisor must also evaluate a patient’s need for continued services and establish a treatment or care plan for the next period if services are still needed. Physicians must approve those services.
These recertifications insure the patient is getting the right services from the proper professionals. They also insure that taxpayers and Medicaid are not getting ripped off for services that may no longer be necessary.
We are concerned that some home visits may not be taking place. To hide that these visits and evaluations are not being properly performed, we believe that non-supervisory staff is perhaps simply filling in the review forms with fictional progress notes.
Prior Frauds and Major Litigation Involving Res-Care
Res-Care is no stranger to allegations of fraud and scams.
In November 2009, a jury returned a verdict of approximately $53.9 million in damages against the company for violations of the New Mexico Resident Abuse and Neglect Act. Approximately $4.7 million of that award was for actual damages. The remaining $49.2 million was for punitive damages. The trial judge later trimmed the punitive damage award to $10.8 million.
The New Mexico jury award didn’t involve fraud but the case was so serious that jurors felt compelled to impose huge punitive damages against the company.
Texas Res-Care Medicaid Fraud
In 2005, ResCare settled Medicaid fraud billing claims brought by the State of Texas and the U.S. Department of Justice. The agencies claimed that the company’s affiliate in Fort Worth, The Citadel Group, back-dated documents and made false billings.
In other words, patients were receiving less care than they should have received.
The complaint said that workers would hold parties on Fridays but bill Medicaid as if they were seeing patients. Although denying any wrongdoing, Res-Care paid $2.15 million to settle the charges and closed its Ft. Worth facility.
The case was originally filed by a whistleblower, a former ResCare mental health provider. In her complaint, she said the company:
- Billed for mental health services that were medically unnecessary or never even provided,
- Doctored patient records to hide their illegal activities,
- Backdated records to insure Medicaid coverage wouldn’t lapse,
- Billed pizza parties as if actual mental health services were being provided, and
- Billed for services while patients were sleeping!
Did Res-Care learn? Apparently not.
Iowa Res Care Medicaid Fraud
In 2015, Res-Care and ResCare Iowa paid $5.63 million to settle Medicaid fraud charges brought by the Justice Department and Iowa. Prosecutors say that physicians were not completing the annual assessments needed for patients receiving homecare.
According to the Justice Department, ‘The rules of both Medicare and the state of Iowa’s Medicaid program require an independent physician to certify that home healthcare services are medically necessary and to order the specific type and amount of healthcare services to be provided by the home health agency.
Additionally, since 2011, Medicare and Iowa Medicaid rules require these independent physicians to perform an in-person “face-to-face” assessment of each patient before the home health agency can bill the government for any home healthcare services. The settlement resolves allegations that between 2009 and 2014, ResCare Iowa billed the government for services provided to Medicare and Medicaid patients in Iowa without documenting compliance with these requirements.”
Res Care and West Virginia (Neglect, Sexual Abuse) Allegations
West Virginia authorities are reportedly investigating the company after a patient recently died while in ResCare’s care. Media reports say the facility where the death occurred has received “dozens” of complaints including claims of neglect, sexual abuse and training deficiencies.
Providing improper or grossly deficient care can be a violation of Medicaid rules. When we entrust a loved one to the care of a professional healthcare company, we assume that they will be protected, receive adequate care and be safe. Improper staffing, patient abuse or improper training can all be violations of Medicaid guidelines.
Indiana Medicaid Fraud
We are also aware of yet another Medicaid fraud case currently making its way through the courts in Indiana. A former ResCare Qualified Intellectual Disabilities Professional (QIDP) filed suit in 2015 claiming that a manager told her that the company did not have enough staff to provide required services needed by patient.
She claims that the manager “advised the QIDPs to begin recording their time spent on preparing developmental and behavioral plans as direct care hours [and] directed the QIDPs to backdate this time to reflect direct care in their progress notes for the month of February.” Medicaid regulations do not allow these services to be billed as direct care.
Her Medicaid fraud case was tossed on technical grounds earlier this year although the judge said she could refile her claim.
ResCare Whistleblowers May be Entitled to Cash Awards
Whistleblowers are the best defense against Medicaid fraud. Government auditors can’t be everywhere, all the time. In fact, auditors can only audit a small fraction of 1% of all providers each year.
Even with an audit, fraud often goes undetected without the help of whistleblowers. This is especially true when companies use phony records and create false documentation.
Under the state and California False Claims Acts, whistleblowers with inside information about Medicaid and Medicare fraud are eligible for large cash awards. Those awards are generally between 15% and 30% of whatever the wrongdoer must pay the government.
The State of California also has a whistleblower award program for insiders with information about fraud involving private insurance carriers.
To qualify for an award, one must have original source (“inside”) knowledge of wrongdoing involving Medicare, Medi-Cal or Medicaid. Failing to provide proper annual and semi-annual recertifications for homecare, billing for ineligible services, over billing, billing for pizza parties and creating false health records are all indicia of Medicaid fraud.
Do you have information about patient abuse or patients being sexually assaulted? We may be able to directly assist patients and their families. Call us today.
Call for ResCare Whistleblowers
If you work or once worked for ResCare, or any of their many affiliates, and have knowledge of fraud or wrongdoing, please give us a call. Cheating Medicaid is a crime, hurts patients and hurts taxpayers. All inquiries are kept confidential and are subject to the attorney client privilege.