Intrepid U.S.A., Inc.
Outcome
Intrepid U.S.A., Inc. paid $3.85 million to resolve False Claims Act allegations covering 19 home health facilities that billed Medicare for patients who did not qualify for or were not properly certified for home health benefits, received services that were not medically necessary, were served by untrained staff, or received services that were not actually performed, as well as three hospice facilities that admitted patients who were not terminally ill.
Details
Intrepid U.S.A., Inc. — Home Health and Hospice False Claims Across 22 Facilities (2024)
Outcome: Intrepid U.S.A., Inc. paid $3.85 million to resolve False Claims Act allegations that 19 of its home health facilities billed Medicare for ineligible, non-medically necessary, or unperformed services — including care delivered by untrained staff — and that three of its hospice facilities admitted and billed for patients who were not terminally ill.
Intrepid U.S.A., Inc. is a Dallas-based home health and hospice company that serves approximately 29,000 patients per year across 14 states. During the period of alleged misconduct, 2016 through 2021, Intrepid was owned by Patriarch Partners, a family office private equity firm.
The home health allegations covered 19 Intrepid facilities across multiple states. The government alleged that these facilities submitted claims to Medicare for patients who did not qualify for the Medicare home health benefit — either because they did not meet homebound status criteria, did not have a qualifying skilled care need, or whose services were not properly certified as medically necessary by a physician. In some instances, the claims were for services that were provided by staff who had not completed the training required for the applicable billing code, and in other instances, for services that were not performed at all.
The hospice allegations covered three Intrepid facilities, which admitted patients to hospice care who were not terminally ill under Medicare's six-months-or-less eligibility standard, or continued providing billable hospice services to patients after those patients no longer met the Medicare hospice criteria and should have been discharged.
The case was brought by four whistleblowers in two separate qui tam actions: Jennifer Jones (former travel nurse) and Pamela Joffe (former Director of Quality Assessment Performance Improvement) filed in the District of Minnesota, and Marsha Rigney (former Director of Clinical Excellence and Integrity) and Janet Watts (former Regional Manager of Clinical Excellence) filed in the Western District of Kentucky. The four whistleblowers collectively received nearly 18% of the government's recovery. The settlement was announced August 20, 2024.
Primary Source: Nationwide Home Healthcare and Hospice Provider To Pay $3.85M To Resolve False Claims Act Allegations — DOJ District of Minnesota
How Crucible Prevents This
Crucible homebound status documentation controls would require clinical staff to complete and attest to homebound eligibility criteria before home health certifications are signed by physicians. A staff training credential verification gate would prevent billing submissions under codes that require certified home health aide training when the delivering staff member's training records are not on file. Medical necessity review workflows requiring a supervisory clinical review before the first billing episode would catch non-qualifying patients before claims are submitted. For hospice lines of business, terminal prognosis documentation requirements with six-month recertification monitoring would enforce the Medicare hospice eligibility standard.
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