Maryland Home Health Care System Settles Medicaid Fraud Allegations

A home healthcare service provider based in Columbia, Maryland, Maxim Healthcare Services, Inc., has entered into settlement agreements with the federal government and several state governments to resolve allegations of fraudulent reimbursement claims. The federal case, which involved both civil and criminal complaints, accused the company of defrauding public programs like Medicaid and the Veterans’ Affairs program out of over $61 million since at least 2003. The complaints alleged a nationwide scheme that involved fraudulent billings to government programs, fraudulent documentation of billing records, and false statements to government officials.

Maxim provides home health care services across the country, which includes full-time homecare services to adult and elderly patients. The company discusses the importance of care planning and home safety on its website. It has a national reach, with hundreds of offices across most U.S. states. Maxim’s services potentially involve the same level of care and responsibility as in the nursing home environment, where the patient becomes fully reliant on the caregiver for support. While it does not provide inpatient care for the elderly, the case demonstrates how a facility can come to place other concerns above the best interests and well-being of its patients, a concern that is always present for nursing home residents.

The federal government’s case against Maxim alleged violations of the False Claims Act, a federal statute first passed in 1863 after widespread fraud by government contractors during the Civil War. Congress has amended the law several times, most recently in 2009 with passage of the Fraud Enforcement and Recovery Act, and in 2010 with the Patient Protection and Affordable Care Act. Generally speaking, the statute prohibits knowingly making false statements or presenting false records in order to receive a payment or benefit from the federal government. Some states also have similar false claims statutes protecting state-level public programs.

The case against Maxim, filed in the U.S. District Court for the District of New Jersey, included civil and criminal charges against the company, criminal charges against former employees, and criminal charges against at least one parent of a former patient. The government accused Maxim of not only defrauding various government programs, but of deceiving its own patients. Some of the allegedly fraudulent transactions included ordering unnecessary treatments for patients in order to increase billing, as well as billing for treatments not actually provided to patients. Nine individual defendants have pleaded guilty to felony charges. Under the settlement agreement, Maxim will pay $20 million as a criminal penalty and $130 million to settle civil claims, including the False Claims Act actions. The settlement, known as a deferred prosecution agreement, also obligated Maxim to agree to a statement of facts mirroring the government’s complaint. Maxim has twenty-four months to comply with the terms of the settlement, or the government may continue its prosecution using the stipulation of facts as evidence.

If you or a loved one has been injured because of negligence in the operation of a nursing home, you may have a claim for compensation. Please contact the experienced Maryland nursing home lawyers at Lebowitz and Mzhen, LLC now to discuss your rights.

More Blog Posts:

October is Long-term Care Residents’ Rights Month in Maryland and around the Country, Maryland Nursing Home Lawyer Blog, October 19, 2011
Hospice Nurse Charged for Elder Abuse and Narcotic Theft, Maryland Nursing Home Lawyer Blog, August 24, 2011
Nursing Home Worker Steals Resident’s Pain Patch for Pleasure, Maryland Nursing Home Lawyer Blog, June 30, 2011
Photo credit: mconnors from morguefile.com

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