Simply Home sues HHS over overpayments

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Thursday, April 18, 2019

CHICAGO – Simply Home Health Care, a home health agency based here, has filed a lawsuit in the U.S. District Court for the Northern District of Illinois against the Department of Health And Human Services and AdvanceMed, a UPIC, for continued suspension of payments from the Medicare program, according to healthcare attorney Elizabeth Hogue. Payments to Simply Home were originally suspended because of overpayments, but the agency was later told by AdvanceMed that payments were suspended because of suspected fraud. While the suspension of payments from Medicare was, ultimately, reversed, AdvanceMed claimed Simply Home owed Medicare $5.4 million, an amount that was later reduced to $4.8 million. Based on the alleged overpayments, Simply Home was forced to go out of business in 2017. Simply Home argues in its case that AdvanceMed didn’t correctly apply federal statutes and regulations, and that it had incentives to claim overpayments to win additional contracts from CMS. “The case is another chapter in the continuing saga of providers vs. UPICs and ZPICs,” Hogue wrote in a bulletin.