Maxim Healthcare Services Inc., a prominent provider of home healthcare services in the U.S., has agreed to a $150 million settlement resolving criminal and civil charges related to a nationwide Medicaid and Veterans Affairs fraud scheme. The company was accused of fraudulently billing over $61 million for services not rendered or not eligible for reimbursement.
Maxim Healthcare Services Admits to Widespread Fraudulent Billing
The scheme, spanning from 2003 to 2009, involved the submission of falsified time sheets, billing through unlicensed offices, and the creation of fraudulent documentation to support claims. During this period, Maxim Healthcare Services received over $2 billion in reimbursements from government healthcare programs across 43 states.
The Department of Justice entered into a deferred prosecution agreement (DPA) with Maxim, allowing the company to avoid a healthcare fraud conviction if it adheres to the DPA’s requirements. These include a $20 million criminal penalty and approximately $130 million in civil settlements.
Nine Individuals Plead Guilty in Connection with Maxim Healthcare Services Fraud
Nine individuals, including eight former Maxim employees and the parent of a former patient, have pleaded guilty to felony charges related to the scheme. These charges range from submitting fraudulent billings to creating false documentation and making false statements to government officials.
Maxim Healthcare Services Implements Remedial Actions
As part of the DPA, Maxim Healthcare Services has acknowledged responsibility for the misconduct and is cooperating with ongoing investigations. The company has also implemented significant reforms, including personnel changes, the establishment of new leadership positions, and increased resources for its compliance program.
Government Officials Emphasize Commitment to Combating Healthcare Fraud
Government officials stressed the importance of safeguarding taxpayer dollars and ensuring the integrity of healthcare programs. They emphasized their commitment to investigating and prosecuting individuals and companies engaged in healthcare fraud.
The settlement includes a corporate integrity agreement with the Department of Health and Human Services Office of Inspector General (HHS-OIG), requiring additional reforms and monitoring. An independent monitor will oversee Maxim’s operations and report on its compliance with healthcare laws and regulations.
Whistleblower Awarded $15.4 Million in Maxim Healthcare Services Case
A whistleblower who filed a lawsuit under the False Claims Act will receive approximately $15.4 million as their share of the recovered funds. The False Claims Act allows private citizens to bring lawsuits on behalf of the government and share in any resulting recovery. This case highlights the vital role whistleblowers play in uncovering fraud and protecting taxpayer dollars. The successful prosecution of Maxim Healthcare Services serves as a deterrent to others who might consider engaging in similar fraudulent activities. It underscores the government’s commitment to upholding the integrity of healthcare programs and ensuring that funds are used for their intended purpose: providing quality care to patients.
