Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

United States ex rel. Berzas v. Health Care Options, Inc.

United States District Court, M.D. Louisiana

November 1, 2019

UNITED STATES OF AMERICA ex rel. MELANIE BERZAS
v.
HEALTH CARE OPTIONS, INC.; HEALTH CARE OPTIONS OF LAFAYETTE, INC.; HOME CARE OPTIONS HOUSTON, INC.; and HOWARD AUSTIN, II, IN HIS CAPACITY AS EXECUTOR OF THE ESTATE OF ANNETTE AUSTIN AND IN HIS INDIVIDUAL CAPACITY

          STIPULATED ORDER AND CONSENT JUDGMENT

         This Stipulated Order and Consent Judgment is entered into among the United States of America, acting through the United States Department of Justice and on behalf of the Office of Inspector General (OIG-HHS) of the Department of Health and Human Services (HHS) (collectively, the “United States”); Health Care Options, Inc.; Health Care Options of Lafayette, Inc.; Home Care Options Houston, Inc.; and Howard Austin, II, in his capacity as executor of the Estate of Annette Austin and in his individual capacity (collectively, “Defendants”); and Melanie Berzas (“Relator”) (hereinafter collectively referred to as the “Parties”), through their authorized representatives.

         RECITALS

         A. Health Care Options, Inc.; Health Care Options of Lafayette, Inc.; and Home Care Options Houston, Inc. are providers of home health services in Louisiana and in Texas. These entities were owned or operated in part by Annette Austin and are owned or operated in part by Howard Austin, II. Howard Austin, II, also serves as the executor of the Estate of Annette Austin.

         B. On March 7, 2014, Melanie Berzas filed a qui tam action in the United States District Court for the Middle District of Louisiana captioned United States of America ex rel. Melanie Berzas v. Health Care Options, Inc., Civil Action No. 14-199-JWD-RLB, pursuant to the qui tam provisions of the False Claims Act, 31 U.S.C. § 3730(b) (the “Civil Action”). Relator alleges that Health Care Options, Inc. has submitted, or has caused to be submitted, false or fraudulent claims for payment to Federal health care programs. The United States has intervened in the Civil Action and has added claims against Health Care Options of Lafayette, Inc.; Home Care Options Houston, Inc.; and Howard Austin, II, in his capacity as executor of the Estate of Annette Austin and in his individual capacity.

         C. The United States contends that Defendants have submitted or have caused to be submitted claims for payment to the Medicare Program, Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395-1395kkk-1 (“Medicare”), and the Medicaid Program, 42 U.S.C. §§ 1396-1396w-5 (“Medicaid”).

         D. The United States contends that it has certain civil claims against Defendants arising from the submission of false and fraudulent claims for payment to Medicare and Medicaid for home health services that did not comply with statutory and regulatory conditions of payment-specifically, face-to-face physician-patient encounters-during the period from 2011 to 2018. That conduct is referred to below as the “Covered Conduct.” E. Relator claims entitlement under 31 U.S.C. § 3730(d) to a share of the proceeds of this Stipulated Order and Consent Judgment and to Relator's reasonable expenses, attorneys' fees, and costs.

         F. Defendants agree to accept service of the United States' complaint and summons.

         G. In order to avoid the delay, uncertainty, inconvenience, and expense of protracted litigation of the above claims, and in consideration of the mutual promises and obligations of this Stipulated Order and Consent Judgment, the Parties agree and covenant as follows:

         TERMS AND CONDITIONS

         1. Defendants consent to the entry of this judgment against them, jointly and severally, and in favor of the United States in the amount of $2, 500, 000.00 (Two Million Five Hundred Thousand Dollars) (the “Judgment Amount”), of which $1, 711, 567.49 is restitution.

         2. The Judgment Amount is a debt to the United States as defined in the Federal Debt Collection Procedures Act of 1990, 28 U.S.C. §§ 3001-3008, and nothing in this Stipulated Order and Consent Judgment precludes the United States from taking action to collect the debt as authorized by law.

         3. Subject to the Terms and Conditions herein, the Judgment Amount shall be considered fully satisfied upon completion of each of the following:

a. On the Effective Date of this Stipulated Order and Consent Judgment, Defendants shall pay to the United States $570, 000.00 (Five Hundred Seventy Thousand Dollars) by electronic funds transfer pursuant to written instructions to be provided by the United States Attorney's Office for the Middle District of Louisiana.
b. On the Effective Date of this Stipulated Order and Consent Judgment, Defendants agree to immediately market for sale the residence at 12991 Highland Road, Baton Rouge, Louisiana 70810 (the “Residence”). The initial listing price for the Residence shall be mutually acceptable to the United States and to Defendants.
(1) Defendants agree to seek and receive prior approval by the United States before reducing the listing price of the Residence at any time.
(2) Should Defendants receive within twelve (12) months of the Effective Date of this Stipulated Order and Consent Judgment an offer to purchase the Residence at or above the listing price effective as of the date of that offer, Defendants may accept the offer without prior approval by the United States.
(3) Defendants agree to seek prior approval by the United States before accepting any offer to purchase the Residence below the listing price effective on the date of the offer.
(4) The net proceeds of any sale of the Residence, constituting gross proceeds less taxes and the costs and fees of closing, shall first be payable toward satisfaction of the primary mortgage on the Residence and any other encumbrances outranking the debt created by this Stipulated Order and Consent Judgment, then toward any commissions owed to real estate agents or brokers in connection with the sale of the Residence, and finally toward the satisfaction of the Judgment Amount.
(5) For the purpose of clarifying the Parties' intent in entering into this Stipulated Order and Consent Judgment, nothing under this Paragraph 3.b other than payment of the net proceeds of the sale of the Residence toward the Judgment Amount, in accordance with Paragraph 3.b. (4), shall constitute a payment to the United States for purposes of Paragraph 3.e, below.
c. Within thirty (30) days of the Effective Date of this Stipulated Order and Consent Judgment, Defendants agree to liquidate all funds in brokerage account number 17568396 with Raymond James Financial Services, Inc., 8280 YMCA Plaza Drive, Bldg. 4, Baton Rouge, Louisiana 70810. Following liquidation, Defendants will immediately pay a sum equal to the net proceeds from that account, constituting gross proceeds less amounts owed to any lien holders, taxes, fees, and costs, to the United States by electronic funds transfer pursuant to written instructions to be provided by the United States Attorney's Office for the Middle District of Louisiana.
d. Defendants have represented that the Estate of Annette Austin is a beneficiary to a pending sale of certain assets related to Health Care Options Hospice of Lafayette, Inc. Defendants agree to immediately notify the United States upon the completion of that sale and to pay a sum equal to the net proceeds from that sale, constituting gross proceeds less taxes, fees, and costs, to the United States within ten (10) days of the effective date of that sale by electronic funds transfer pursuant to written instructions to be provided by the United States Attorney's Office for the Middle District of Louisiana.
e. Notwithstanding any other provision of this Paragraph 3, in the event that total payments to the United States under this Paragraph 3 do not equal or exceed $2, 500, 000.00 (Two Million Five Hundred Thousand Dollars) within twelve (12) months of the Effective Date of this Stipulated Order and Consent Judgment, Defendants shall pay, within thirty (30) days following twelve months after the Effective Date of this Stipulated Order and Consent Judgment, to the ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.