Infinity Home Care of Lakeland, a Florida-based home health provider and affiliate of Amedisys, has sued the U.S. Department of Health and Human Services over Medicare recoupments.
The Florida-based home health agency alleged that HHS completed “shoddy expert work” that led the agency to conclude that Medicare overpaid Infinity by $34 million for services from 2014 to 2016.
According to the lawsuit, a contractor, Zone Program Integrity Contractors (ZPIC), reviewed 72 of the agency’s claims in 2017 and denied all 72 on the basis of errors with the face-to-face encounter documentation, that home health services were not medically reasonable and necessary or a lack of medical records. The contractor then extrapolated its allegations to another 11,240 claims that it had not reviewed and asserted that Infinity had been overpaid by a total of $34 million.
“With Infinity being an established provider and part of one of the largest and most respected home health companies in the country, Amedisys, the ZPIC’s allegations that 100% of Infinity’s claims were erroneous does not pass the straight-face test,” the lawsuit read.
Amedisys did not respond to Home Health Care News’ request for comment by the time of publication.
Amedisys acquired Infinity HomeCare in 2015 for $63 million. At that time, Infinity provided care for more than 14,000 patients annually and employed over 600 people.
Per the lawsuit, in the years following the contractor’s findings, Infinity worked with an independent expert statistician to assess the contractor’s findings and requested a redetermination and reconsideration of the contractor’s conclusions. The agency also filed an appeal and requested a hearing, but the Administrative Law Judge (ALJ) upheld 51 of 57 beneficiary claims.
In 2022, according to the lawsuit, Amedisys paid $34 million on Infinity’s behalf to avoid further punitive interest. Infinity is seeking repayment for that amount, plus interest.
The agency also alleges that it has not received protections typically accorded to defendants facing millions of dollars of damages and was hampered in its ability to defend against legal claims.
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