0001193125-14-386631.txt : 20141029 0001193125-14-386631.hdr.sgml : 20141029 20141029123003 ACCESSION NUMBER: 0001193125-14-386631 CONFORMED SUBMISSION TYPE: 10-Q PUBLIC DOCUMENT COUNT: 12 CONFORMED PERIOD OF REPORT: 20140930 FILED AS OF DATE: 20141029 DATE AS OF CHANGE: 20141029 FILER: COMPANY DATA: COMPANY CONFORMED NAME: AMEDISYS INC CENTRAL INDEX KEY: 0000896262 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HOME HEALTH CARE SERVICES [8082] IRS NUMBER: 113131700 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 10-Q SEC ACT: 1934 Act SEC FILE NUMBER: 000-24260 FILM NUMBER: 141179266 BUSINESS ADDRESS: STREET 1: 5959 S SHERWOOD FOREST BLVD CITY: BATON ROUGE STATE: LA ZIP: 70816 BUSINESS PHONE: 2252922031 MAIL ADDRESS: STREET 1: 5959 S SHERWOOD FOREST BLVD CITY: BATON ROUGE STATE: LA ZIP: 70816 FORMER COMPANY: FORMER CONFORMED NAME: ANALYTICAL NURSING MANAGEMENT CORP DATE OF NAME CHANGE: 19940819 FORMER COMPANY: FORMER CONFORMED NAME: M&N CAPITAL CORP DATE OF NAME CHANGE: 19930125 10-Q 1 d787955d10q.htm 10-Q 10-Q
Table of Contents

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington D.C. 20549

 

 

FORM 10-Q

 

 

(Mark One)

x QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2014

or

 

¨ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from                      to                     

Commission File Number: 0-24260

 

 

 

 

LOGO

AMEDISYS, INC.

(Exact Name of Registrant as Specified in its Charter)

 

 

 

Delaware   11-3131700

(State or other jurisdiction of

incorporation or organization)

 

(I.R.S. Employer

Identification No.)

5959 S. Sherwood Forest Blvd., Baton Rouge, LA 70816

(Address of principal executive offices, including zip code)

(225) 292-2031 or (800) 467-2662

(Registrant’s telephone number, including area code)

 

 

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes  x    No  ¨

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).    Yes  x    No  ¨

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer,” and “smaller reporting company” in Rule 12b-2 of the Exchange Act. (Check one):

 

Large accelerated filer   ¨    Accelerated filer   x
Non-accelerated filer   ¨  (Do not check if a smaller reporting company)    Smaller reporting company   ¨

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    Yes  ¨    No  x

The number of shares outstanding of each of the issuer’s classes of common stock, as of the latest practicable date, is as follows: Common stock, $0.001 par value, 33,380,425 shares outstanding as of October 24, 2014.

 

 

 


Table of Contents

TABLE OF CONTENTS

 

SPECIAL CAUTION CONCERNING FORWARD-LOOKING STATEMENTS

     1   

PART I. FINANCIAL INFORMATION

  

ITEM 1.

  

FINANCIAL STATEMENTS (UNAUDITED):

  
  

CONDENSED CONSOLIDATED BALANCE SHEETS AS OF SEPTEMBER 30, 2014 AND DECEMBER 31, 2013

     2   
  

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS FOR THE THREE AND NINE-MONTH PERIODS ENDED SEPTEMBER 30, 2014 AND 2013

     3   
  

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS FOR THE NINE-MONTH PERIODS ENDED SEPTEMBER 30, 2014 AND 2013

     4   
  

NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

     5   

ITEM 2.

  

MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

     17   

ITEM 3.

  

QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

     30   

ITEM 4.

  

CONTROLS AND PROCEDURES

     31   

PART II. OTHER INFORMATION

  

ITEM 1.

  

LEGAL PROCEEDINGS

     31   

ITEM 1A.

  

RISK FACTORS

     31   

ITEM 2.

  

UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

     32   

ITEM 3.

  

DEFAULTS UPON SENIOR SECURITIES

     32   

ITEM 4.

  

MINE SAFETY DISCLOSURES

     32   

ITEM 5.

  

OTHER INFORMATION

     32   

ITEM 6.

  

EXHIBITS

     32   

SIGNATURES

     35   

INDEX TO EXHIBITS

     36   


Table of Contents

SPECIAL CAUTION CONCERNING FORWARD-LOOKING STATEMENTS

When included in this Quarterly Report on Form 10-Q, or in other documents that we file with the Securities and Exchange Commission (“SEC”) or in statements made by or on behalf of the Company, words like “believes,” “belief,” “expects,” “plans,” “anticipates,” “intends,” “projects,” “estimates,” “may,” “might,” “would,” “should” and similar expressions are intended to identify forward-looking statements as defined by the Private Securities Litigation Reform Act of 1995. These forward-looking statements involve a variety of risks and uncertainties that could cause actual results to differ materially from those described therein. These risks and uncertainties include, but are not limited to the following: changes in Medicare and other medical payment levels, our ability to open care centers, acquire additional care centers and integrate and operate these care centers effectively, changes in or our failure to comply with existing Federal and state laws or regulations or the inability to comply with new government regulations on a timely basis, competition in the home health industry, changes in the case mix of patients and payment methodologies, changes in estimates and judgments associated with critical accounting policies, our ability to maintain or establish new patient referral sources, our ability to attract and retain qualified personnel, changes in payments and covered services due to the economic downturn and deficit spending by Federal and state governments, future cost containment initiatives undertaken by third-party payors, our access to financing due to the volatility and disruption of the capital and credit markets, our ability to meet debt service requirements and comply with covenants in debt agreements, business disruptions due to the natural disasters or act of terrorism, our ability to integrate and manage our information systems, our ability to comply with requirements stipulated in our corporate integrity agreement and changes in law or developments with respect to any litigation relating to the Company, including various other matters, many of which are beyond our control.

Because forward-looking statements are inherently subject to risks and uncertainties, some of which cannot be predicted or quantified, you should not rely on any forward-looking statement as a prediction of future events. We expressly disclaim any obligation or undertaking and we do not intend to release publicly any updates or changes in our expectations concerning the forward-looking statements or any changes in events, conditions or circumstances upon which any forward-looking statement may be based, except as required by law. For a discussion of some of the factors discussed above as well as additional factors, see our Annual Report on Form 10-K for the year ended December 31, 2013, filed with the SEC on March 12, 2014, particularly Part I, Item 1A. – “Risk Factors” therein, which are incorporated herein by reference and Part II, Item 1A. – “Risk Factors” of this Quarterly Report on Form 10-Q. Additional risk factors may also be described in reports that we file from time to time with the SEC.

Available Information

Our company website address is www.amedisys.com. We use our website as a channel of distribution for important company information. Important information, including press releases, analyst presentations and financial information regarding our company, is routinely posted on and accessible on the Investor Relations subpage of our website, which is accessible by clicking on the tab labeled “Investors” on our website home page. We also use our website to expedite public access to time-critical information regarding our company in advance of or in lieu of distributing a press release or a filing with the SEC disclosing the same information. Therefore, investors should look to the Investor Relations subpage of our website for important and time-critical information. Visitors to our website can also register to receive automatic e-mail and other notifications alerting them when new information is made available on the Investor Relations subpage of our website. In addition, we make available on the Investor Relations subpage of our website (under the link “SEC filings”) free of charge our annual reports on Form 10-K, quarterly reports on Form 10-Q, current reports on Form 8-K, ownership reports on Forms 3, 4 and 5 and any amendments to those reports as soon as practicable after we electronically file such reports with the SEC. Further, copies of our Certificate of Incorporation and Bylaws, our Code of Ethical Business Conduct, our Corporate Governance Guidelines and the charters for the Audit, Compensation, Quality of Care, Compliance and Ethics and Nominating and Corporate Governance Committees of our Board are also available on the Investor Relations subpage of our website (under the link “Corporate Governance”).

Additionally, the public may read and copy any of the materials we file with the SEC at the SEC’s Public Reference Room at 100 F Street, NE, Room 1580, Washington, D.C. 20549. Information on the operation of the Public Reference Room may be obtained by calling the SEC at (800) SEC-0330. Our electronically filed reports can also be obtained on the SEC’s internet site at http://www.sec.gov.

 

1


Table of Contents

PART I. FINANCIAL INFORMATION

ITEM 1. FINANCIAL STATEMENTS

AMEDISYS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED BALANCE SHEETS

(Amounts in thousands, except share data)

(Unaudited)

 

     September 30, 2014     December 31, 2013  
ASSETS     

Current assets:

    

Cash and cash equivalents

   $ 5,542     $ 17,303  

Patient accounts receivable, net of allowance for doubtful accounts of $15,640 and $14,231

     102,859       111,133  

Prepaid expenses

     11,303       10,669  

Deferred income taxes

     10,153       55,329  

Other current assets

     12,577       10,785  

Assets held for sale

     —         60  
  

 

 

   

 

 

 

Total current assets

     142,434       205,279  

Property and equipment, net of accumulated depreciation of $142,066 and $129,891

     141,419       159,025  

Goodwill

     205,587       208,915  

Intangible assets, net of accumulated amortization of $25,370 and $25,133

     34,096       36,690  

Deferred income taxes

     128,478       90,214  

Other assets, net

     30,199       26,283  
  

 

 

   

 

 

 

Total assets

   $ 682,213     $ 726,406  
  

 

 

   

 

 

 
LIABILITIES AND EQUITY     

Current liabilities:

    

Accounts payable

   $ 19,363     $ 20,139  

Accrued charge related to U.S. Department of Justice settlement

     35,000       150,000  

Payroll and employee benefits

     71,208       70,801  

Accrued expenses

     53,494       57,572  

Current portion of long-term obligations

     12,000       13,904  
  

 

 

   

 

 

 

Total current liabilities

     191,065       312,416  

Long-term obligations, less current portion

     102,299       33,000  

Other long-term obligations

     5,748       8,511  
  

 

 

   

 

 

 

Total liabilities

     299,112       353,927  
  

 

 

   

 

 

 

Commitments and Contingencies - Note 6

    

Equity:

    

Preferred stock, $0.001 par value, 5,000,000 shares authorized; none issued or outstanding

     —         —    

Common stock, $0.001 par value, 60,000,000 shares authorized; 34,306,877, and 33,413,970 shares issued; and 33,347,852 and 32,538,971 shares outstanding

     34       33  

Additional paid-in capital

     477,115       467,890  

Treasury stock at cost 959,025, and 874,999 shares of common stock

     (19,483     (18,176

Accumulated other comprehensive income

     15       15  

Retained earnings

     (73,920     (77,561
  

 

 

   

 

 

 

Total Amedisys, Inc. stockholders’ equity

     383,761       372,201  

Noncontrolling interests

     (660     278  
  

 

 

   

 

 

 

Total equity

     383,101       372,479  
  

 

 

   

 

 

 

Total liabilities and equity

   $ 682,213     $ 726,406  
  

 

 

   

 

 

 

The accompanying notes are an integral part of these condensed consolidated financial statements.

 

2


Table of Contents

AMEDISYS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS

(Amounts in thousands, except per share data)

(Unaudited)

 

     For the Three-Month Periods
Ended September 30,
    For the Nine-Month Periods
Ended September 30,
 
     2014     2013     2014     2013  

Net service revenue

   $ 300,281     $ 301,285     $ 904,026     $ 945,847  

Cost of service, excluding depreciation and amortization

     170,159       175,233       519,686       538,660  

General and administrative expenses:

        

Salaries and benefits

     69,461       73,906       224,032       228,758  

Non-cash compensation

     1,697       1,653       3,197       4,933  

Other

     32,018       40,308       110,240       123,534  

Provision for doubtful accounts

     4,183       3,944       13,318       12,437  

Depreciation and amortization

     6,515       8,925       22,109       28,306  

U.S. Department of Justice settlement

     —         150,000       —         150,000  

Other intangibles impairment charge

     —         1,542       2,208       3,828  
  

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses

     284,033       455,511       894,790       1,090,456  
  

 

 

   

 

 

   

 

 

   

 

 

 

Operating income (loss)

     16,248       (154,226     9,236       (144,609

Other (expense) income:

        

Interest income

     24       18       46       40  

Interest expense

     (2,990     (672     (5,603     (2,478

Equity in earnings from equity investments

     563       354       2,234       1,054  

Miscellaneous, net

     110       6,553       544       6,075  
  

 

 

   

 

 

   

 

 

   

 

 

 

Total other (expense) income, net

     (2,293     6,253       (2,779     4,691  
  

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

     13,955       (147,973     6,457       (139,918

Income tax (expense) benefit

     (5,358     56,928       (2,483     53,736  
  

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) from continuing operations

     8,597       (91,045     3,974       (86,182

Discontinued operations, net of tax

     —         (733     (216     (1,615
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss)

     8,597       (91,778     3,758       (87,797

Net (income) loss attributable to noncontrolling interests

     (158     709       (117     1,248  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to Amedisys, Inc.

   $ 8,439     $ (91,069   $ 3,641     $ (86,549
  

 

 

   

 

 

   

 

 

   

 

 

 

Basic earnings per common share:

        

Income (loss) from continuing operations attributable to Amedisys, Inc. common stockholders

   $ 0.26     $ (2.87   $ 0.12     $ (2.73

Discontinued operations, net of tax

     —         (0.02     (0.01     (0.05
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to Amedisys, Inc. common stockholders

   $ 0.26     $ (2.89   $ 0.11     $ (2.78
  

 

 

   

 

 

   

 

 

   

 

 

 

Weighted average shares outstanding

     32,468       31,505       32,194       31,102  
  

 

 

   

 

 

   

 

 

   

 

 

 

Diluted earnings per common share:

        

Income (loss) from continuing operations attributable to Amedisys, Inc. common stockholders

   $ 0.26     $ (2.87   $ 0.12     $ (2.73

Discontinued operations, net of tax

     —         (0.02     (0.01     (0.05
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to Amedisys, Inc. common stockholders

   $ 0.26     $ (2.89   $ 0.11     $ (2.78
  

 

 

   

 

 

   

 

 

   

 

 

 

Weighted average shares outstanding

     32,934       31,505       32,690       31,102  
  

 

 

   

 

 

   

 

 

   

 

 

 

Amounts attributable to Amedisys, Inc. common stockholders:

        

Income (loss) from continuing operations

   $ 8,439     $ (90,336   $ 3,857     $ (84,934

Discontinued operations, net of tax

     —         (733     (216     (1,615
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss)

   $ 8,439     $ (91,069   $ 3,641     $ (86,549
  

 

 

   

 

 

   

 

 

   

 

 

 

The accompanying notes are an integral part of these condensed consolidated financial statements.

 

3


Table of Contents

AMEDISYS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(Amounts in thousands)

(Unaudited)

 

     For the Nine-Month Periods
Ended September 30,
 
     2014     2013  

Cash Flows from Operating Activities:

    

Net income (loss)

   $ 3,758     $ (87,797

Adjustments to reconcile net income (loss) to net cash provided by operating activities:

    

Depreciation and amortization

     22,149       28,730  

Provision for doubtful accounts

     13,392       12,853  

Non-cash compensation

     3,197       4,933  

401(k) employer match

     4,682       6,200  

Loss on disposal of property and equipment

     4,174       1,239  

Gain on sale of care centers

     (2,967     (1,808

Deferred income taxes

     6,357       (53,611

Write off of deferred debt issuance costs

     488       —    

Equity in earnings of equity investments

     (2,234     (1,054

Amortization of deferred debt issuance costs

     521       548  

Return on equity investment

     1,500       975  

Other intangibles impairment charge

     2,208       3,828  

Changes in operating assets and liabilities, net of impact of acquisitions:

    

Patient accounts receivable

     (5,848     45,170  

Other current assets

     (1,885     1,409  

Other assets

     1,554       (2,069

Accounts payable

     668       (8,111

U.S. Department of Justice settlement accrual

     (115,000     150,000  

Accrued expenses

     (4,081     (11,198

Other long-term obligations

     (2,762     3,625  
  

 

 

   

 

 

 

Net cash (used in) provided by operating activities

     (70,129     93,862  
  

 

 

   

 

 

 

Cash Flows from Investing Activities:

    

Proceeds from sale of deferred compensation plan assets

     9       128  

Proceeds from the sale of property and equipment

     3       126  

Purchases of deferred compensation plan assets

     (104     (93

Purchases of property and equipment

     (9,882     (28,983

Purchases of investments

     (3,421     (9,732

Acquisitions of businesses, net of cash acquired

     —         (627

Proceeds from dispositions of care centers, net of cash sold

     4,233       3,725  
  

 

 

   

 

 

 

Net cash used in investing activities

     (9,162     (35,456
  

 

 

   

 

 

 

Cash Flows from Financing Activities:

    

Proceeds from issuance of stock upon exercise of stock options

     89       258  

Proceeds from issuance of stock to employee stock purchase plan

     1,875       2,436  

Non-controlling interest distribution

     —         (163

Proceeds from revolving line of credit

     200,800       25,500  

Repayments of revolving line of credit

     (190,800     (25,500

Proceeds from issuance of long-term obligations

     67,371       —    

Debt issuance costs

     (901     —    

Principal payments of long-term obligations

     (10,904     (31,856
  

 

 

   

 

 

 

Net cash provided by (used in) financing activities

     67,530       (29,325
  

 

 

   

 

 

 

Net (decrease) increase in cash and cash equivalents

     (11,761     29,081  

Cash and cash equivalents at beginning of period

     17,303       14,545  
  

 

 

   

 

 

 

Cash and cash equivalents at end of period

   $ 5,542     $ 43,626  
  

 

 

   

 

 

 

Supplemental Disclosures of Cash Flow Information:

    

Cash paid for interest

   $ 4,771     $ 2,384  
  

 

 

   

 

 

 

Cash paid for income taxes, net of refunds received

   $ 13     $ 3,235  
  

 

 

   

 

 

 

Supplemental Disclosures of Non-Cash Financing and Investing Activities:

    

(Sale) acquisition of non-controlling interests

   $ (1,549   $ 312  
  

 

 

   

 

 

 

The accompanying notes are an integral part of these condensed consolidated financial statements.

 

4


Table of Contents

AMEDISYS, INC. AND SUBSIDIARIES

NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

1. NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS

Amedisys, Inc., a Delaware corporation, and its consolidated subsidiaries (“Amedisys,” “we,” “us,” or “our”) are a multi-state provider of home health and hospice services with approximately 81% and 84% of our revenue derived from Medicare for the three-month periods ended September 30, 2014 and 2013, respectively, and approximately 82% and 84% our revenue derived from Medicare for the nine-month periods ended September 30, 2014 and 2013, respectively. As of September 30, 2014, we owned and operated 316 Medicare-certified home health care centers and 80 Medicare-certified hospice care centers in 34 states within the United States, the District of Columbia and Puerto Rico.

Basis of Presentation

In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting solely of normal recurring adjustments) necessary to present fairly our financial position, our results of operations and our cash flows in accordance with U.S. Generally Accepted Accounting Principles (“U.S. GAAP”). Our results of operations for the interim periods presented are not necessarily indicative of results of our operations for the entire year and have not been audited by our independent auditors.

Certain information and footnote disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted from the interim financial information presented. This report should be read in conjunction with our consolidated financial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 2013 as filed with the Securities and Exchange Commission (“SEC”) on March 12, 2014 (the “Form 10-K”), which includes information and disclosures not included herein.

Use of Estimates

Our accounting and reporting policies conform with U.S. GAAP. In preparing the unaudited condensed consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates.

Reclassifications and Comparability

Certain reclassifications have been made to prior period’s financial statements in order to conform to the current period’s presentation.

Principles of Consolidation

These unaudited condensed consolidated financial statements include the accounts of Amedisys, Inc., and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying unaudited condensed consolidated financial statements, and business combinations accounted for as purchases have been included in our unaudited condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain investments that are accounted for as set forth below.

Investments

We consolidate investments when the entity is a variable interest entity and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50%. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our condensed consolidated financial statements.

We account for investments in entities in which we have the ability to exercise significant influence under the equity method if we hold 50% or less of the voting stock and the entity is not a variable interest entity in which we are the primary beneficiary. The book value of investments that we accounted for under the equity method of accounting was $15.5 million as of September 30, 2014, and $11.9 million as of December 31, 2013. We account for investments in entities in which we have less than a 20% ownership interest under the cost method of accounting if we do not have the ability to exercise significant influence over the investee. The aggregate carrying amount of our cost method investment was $5.0 million as of September 30, 2014 and December 31, 2013.

2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Revenue Recognition

We earn net service revenue through our home health and hospice care centers by providing a variety of services almost exclusively in the homes of our patients. This net service revenue is earned and billed either on an episode of care basis, on a per visit basis or on a daily basis depending upon the payment terms and conditions established with each payor for services provided. We refer to home health revenue earned and billed on a 60-day episode of care as episodic-based revenue.

When we record our service revenue, we record it net of estimated revenue adjustments and contractual adjustments to reflect amounts we estimate to be realizable for services provided, as discussed below. We believe, based on information currently available to us and

 

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Table of Contents

AMEDISYS, INC. AND SUBSIDIARIES

NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

 

based on our judgment, that changes to one or more factors that impact the accounting estimates (such as our estimates related to revenue adjustments, contractual adjustments and episodes in progress) we make in determining net service revenue, which changes are likely to occur from period to period, will not materially impact our reported consolidated financial condition, results of operations, cash flows or our future financial results.

Home Health Revenue Recognition

Medicare Revenue

Net service revenue is recorded under the Medicare prospective payment system (“PPS”) based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if our patient’s care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits was fewer than five; (c) a partial payment if our patient transferred to another provider or we received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required (with various incremental adjustments made for additional visits, with larger payment increases associated with the sixth, fourteenth and twentieth visit thresholds); (e) adjustments to payments if we are unable to perform periodic therapy assessments; (f) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (g) changes in the base episode payments established by the Medicare Program; (h) adjustments to the base episode payments for case mix and geographic wages; and (i) recoveries of overpayments. In addition, we make adjustments to Medicare revenue if we find that we are unable to produce appropriate documentation of a face to face encounter between the patient and physician.

We make adjustments to Medicare revenue to reflect differences between estimated and actual payment amounts, our discovered inability to obtain appropriate billing documentation or authorizations and other reasons unrelated to credit risk. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record this estimate during the period in which services are rendered as an estimated revenue adjustment and a corresponding reduction to patient accounts receivable. Therefore, we believe that our reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered.

In addition to revenue recognized on completed episodes, we also recognize a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. We estimate this revenue on a monthly basis based upon historical trends. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and our estimate of the average percentage complete based on visits performed. As of September 30, 2014 and 2013, the difference between the cash received from Medicare for a request for anticipated payment (“RAP”) on episodes in progress and the associated estimated revenue was immaterial and, therefore, the resulting credits were recorded as a reduction to our outstanding patient accounts receivable in our condensed consolidated balance sheets for such periods.

Non-Medicare Revenue

Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms.

Non-episodic based Revenue. Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates, as applicable. Contractual adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue and are also recorded as a reduction to our outstanding patient accounts receivable. In addition, we receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment.

Hospice Revenue Recognition

Hospice Medicare Revenue

Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily or hourly rates for each of the four levels of care we deliver. The four levels of care are routine care, general inpatient care, continuous home care and respite care. Routine care accounts for 96% and 100% of our total Medicare hospice service revenue for the three-month periods ended September 30, 2014 and 2013, respectively, and 98% and 99% of our total Medicare hospice service revenue for the nine-month periods ended September 30, 2014 and 2013, respectively. We make adjustments to Medicare revenue for an inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these adjustments based on our historical experience, which primarily includes our historical collection rate on Medicare claims, and record it during the period services are rendered as an estimated revenue adjustment and as a reduction to our outstanding patient accounts receivable.

 

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(Unaudited)

 

Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap for each provider number, we monitor these caps and estimate amounts due back to Medicare if a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in other accrued liabilities. We have settled our Medicare hospice reimbursements for all fiscal years through October 31, 2012 as of September 30, 2014. As of September 30, 2014, we have recorded $2.8 million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2013 through October 31, 2014. As of December 31, 2013, we have recorded $4.0 million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2012 through October 31, 2014.

Hospice Non-Medicare Revenue

We record gross revenue on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per day rates, as applicable. Contractual adjustments are recorded for the difference between our established rates and the amounts estimated to be realizable from patients, third parties and others for services provided and are deducted from gross revenue to determine our net service revenue and patient accounts receivable.

Patient Accounts Receivable

Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. There is no single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables, and thus we believe there are no other significant concentrations of receivables that would subject us to any significant credit risk in the collection of our patient accounts receivable. We fully reserve for accounts which are aged at 365 days or greater. We write off accounts on a monthly basis once we have exhausted our collection efforts and deem an account to be uncollectible.

We believe the credit risk associated with our Medicare accounts, which represent 67% of our net patient accounts receivable at September 30, 2014 and December 31, 2013, is limited due to our historical collection rate of over 99% from Medicare and the fact that Medicare is a U.S. government payor. Accordingly, we do not record an allowance for doubtful accounts for our Medicare patient accounts receivable, which are recorded at their net realizable value after recording estimated revenue adjustments as discussed above. During the three and nine-month periods ended September 30, 2014, we recorded $1.4 million and $4.1 million, respectively, in estimated revenue adjustments to Medicare as compared to $2.5 million and $9.1 million during the three and nine-month periods ended September 30, 2013, respectively.

We believe there is a certain level of credit risk associated with non-Medicare payors. To provide for our non-Medicare patient accounts receivable that could become uncollectible in the future, we establish an allowance for doubtful accounts to reduce the carrying amount to its estimated net realizable value.

Medicare Home Health

For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for 60% of our estimated payment for the initial episode at the start of care or 50% of the estimated payment for any subsequent episodes of care contiguous with the first episode for a particular patient. The full amount of the episode is billed after the episode has been completed (“final billed”). The RAP received for that particular episode is then deducted from our final payment. If a final bill is not submitted within the greater of 120 days from the start of the episode, or 60 days from the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare from any other claims in process for that particular provider number. The RAP and final claim must then be re-submitted.

Medicare Hospice

For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. Once each patient has been confirmed for eligibility, we will bill Medicare on a monthly basis for the services provided to the patient.

Non-Medicare Home Health and Hospice

For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient’s eligibility for services with the applicable payor. Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor. Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk. We estimate an allowance for doubtful accounts based upon our assessment of historical and expected net collections, business and economic conditions, trends in payment and an evaluation of collectibility based upon the date that the service was provided. Based upon our best judgment, we believe the allowance for doubtful accounts adequately provides for accounts that will not be collected due to credit risk.

 

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NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

 

Fair Value of Financial Instruments

The following details our financial instruments where the carrying value and the fair value differ (amounts in millions):

 

            Fair Value at Reporting Date Using  

Financial Instrument

   Carrying Value as
of September 30,
2014
     Quoted Prices in
Active Markets for
Identical Items

(Level 1)
     Significant Other
Observable Inputs

(Level 2)
     Significant
Unobservable Inputs

(Level 3)
 

Long-term obligations

   $ 114.3      $ —        $ 115.4      $ —    

The estimates of the fair value of our long-term debt are based upon a discounted present value analysis of future cash flows. Due to the uncertainty in the capital and credit markets the actual rates that would be obtained to borrow under similar conditions could materially differ from the estimates we have used.

The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows:

 

    Level 1 – Quoted prices in active markets for identical assets and liabilities.

 

    Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.

 

    Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities.

For our other financial instruments, including our cash and cash equivalents, patient accounts receivable, accounts payable and accrued expenses, we estimate the carrying amounts’ approximate fair value. Our deferred compensation plan assets are recorded at fair value.

Weighted-Average Shares Outstanding

Net income (loss) per share attributable to Amedisys, Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calculate our basic and diluted net income (loss) attributable to Amedisys, Inc. common stockholders (amounts in thousands):

 

     For the Three-Month Periods
Ended September 30,
     For the Nine-Month Periods
Ended September 30,
 
     2014      2013      2014      2013  

Weighted average number of shares outstanding - basic

     32,468        31,505        32,194        31,102  

Effect of dilutive securities:

           

Stock options

     —          —          —          —    

Non-vested stock and stock units

     466        —          496        —    
  

 

 

    

 

 

    

 

 

    

 

 

 

Weighted average number of shares outstanding - diluted

     32,934        31,505        32,690        31,102  
  

 

 

    

 

 

    

 

 

    

 

 

 

Anti-dilutive securities

     51        682        107        640  
  

 

 

    

 

 

    

 

 

    

 

 

 

Recently Issued Accounting Pronouncements

In April 2014, the FASB issued Accounting Standards Update (“ASU”) 2014-08, Presentation of Financial Statements (Topic 205) and Property, Plant, and Equipment (Topic 360): Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity changing the criteria for reporting discontinued operations. The ASU states that only those disposed components (or components held-for-sale) representing a strategic shift that have (or will have) a major effect on operations and financial results (or that are businesses or non-profit activities held-for-sale at acquisition) will be reported in discontinued operations. The ASU also required expanded disclosures about discontinued operations in the financial statement notes. The ASU is effective for disposals (or classifications as held-for-sale) that occur within annual periods beginning on or after December 15, 2014 and interim periods within those annual periods. Early application is permitted, but only for those disposals (or classifications as held-for-sale) that have not been reported in financial statements previously issued or available for issuance. We have chosen to early adopt this ASU and have applied the new criteria in determining the accounting treatment for the care centers exited during 2014.

 

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(Unaudited)

 

In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606), which requires an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised goods or services to customers. The ASU will replace most existing revenue recognition guidance in U.S. GAAP when it becomes effective on January 1, 2017. Early application is not permitted. The standard permits the use of either the retrospective or cumulative effect transition method. The Company is evaluating the effect that ASU 2014-09 will have on its consolidated financial statements and related disclosures. The Company has not yet selected a transition method nor has it determined the effect of the standard on its ongoing financial reporting.

3. DISCONTINUED OPERATIONS AND ASSETS HELD FOR SALE

As part of our management of our portfolio of care centers, we review each care center’s current financial performance, market penetration, forecasted market growth and the impact of proposed CMS payment revisions. As a result of our review, we consolidated 41 home health care centers and five hospice care centers with care centers servicing the same markets, sold 19 home health care centers and one hospice care center and closed 10 home health care centers during 2013. We had previously classified 28 of these care centers as held for sale during 2013 and three care centers remained classified as held for sale at December 31, 2013. During the three-month period ended March 31, 2014, we sold assets associated with one of these care centers and consolidated one of these care centers with a care center servicing the same market. During the three-month period ended June 30, 2014, we sold assets associated with the remaining care center; there are no care centers classified as held for sale as of September 30, 2014. For additional information on the care centers consolidated with care centers servicing the same markets and the care centers sold, see Note 4 – Exit and Restructuring Activities.

Net revenues and operating results for the periods presented for the care centers classified as discontinued operations are as follows (dollars in millions):

 

     For the Three-Month Periods Ended
September 30,
    For the Nine-Month Periods Ended
September 30,
 
     2014      2013     2014     2013  

Net revenues

   $ —        $ 7.7     $ (0.3   $ 27.2  

Loss before income taxes

     —          (1.2     (0.3     (2.7

Income tax benefit

     —          0.5       0.1       1.1  
  

 

 

    

 

 

   

 

 

   

 

 

 

Discontinued operations, net of tax

   $ —        $ (0.7   $ (0.2   $ (1.6
  

 

 

    

 

 

   

 

 

   

 

 

 

4. EXIT AND RESTRUCTURING ACTIVITIES

Exit Activity

As of December 31, 2013, we reported three home health care centers as held for sale. During the three-month period ended March 31, 2014, we sold assets associated with one of these care centers for cash consideration of approximately $0.6 million and recognized a gain of approximately $0.6 million which is included in discontinued operations. In addition, during the three months ended March 31, 2014, one of the care centers classified as held for sale as of December 31, 2013 was consolidated with a care center servicing the same market. During the three-month period ended June 30, 2014, we sold assets associated with the remaining care center for cash consideration of approximately $0.2 million and recognized a gain of approximately $0.2 million which is included in discontinued operations.

Effective April 17, 2014, the Company sold its interest in five home health and four hospice care centers in Wyoming and Idaho for approximately $5.0 million and recognized a gain of $2.1 million.

Effective September 5, 2014, the Company exited its hospice inpatient unit in New Hampshire and recognized a loss of $0.5 million.

In addition to the sale of the care centers mentioned above, during the three months ended March 31, 2014, we consolidated three home health care centers with care centers servicing the same markets and closed four home health care centers and one hospice care center and announced our plans to close or consolidate another 43 care centers. In connection with these care centers, we recorded non-cash charges of $2.2 million in other intangibles impairment expense related to the write-off of intangible assets, $2.1 million in other general and administrative expenses related to lease termination costs and $2.1 million in salaries and benefits related to severance costs during the three-month period ended March 31, 2014. These care centers were not concentrated in certain selected

 

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(Unaudited)

 

geographical areas and did not meet the criteria to be classified as discontinued operations in accordance with applicable accounting guidance. During the three-month period ended June 30, 2014, we completed the closure of the remaining 43 care centers as follows: we consolidated 18 home health care centers and four hospice care centers with care centers servicing the same markets and closed 18 home health care centers and three hospice care centers.

Restructuring Activity

During the quarter ended March 31, 2014, we restructured our regional leadership and corporate support functions. As such, we recorded charges of $3.4 million in salaries and benefits related to severance costs during the three-month period ended March 31, 2014. In addition, on February 20, 2014, William F. Borne stepped down from his positions as Chief Executive Officer, Chairman and a member of our Board of Directors and we recorded charges of $2.3 million in salaries and benefits related to severance costs.

5. LONG-TERM OBLIGATIONS

Long-term debt consisted of the following for the periods indicated (amounts in millions):

 

     September 30,
2014
    December 31,
2013
 

$60.0 million Term Loan; $3.0 million principal payments plus accrued interest payable quarterly; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (3.41% at September 30, 2014); due October 26, 2017

   $ 36.0     $ 45.0  

$120.0 million Revolving Credit Facility; interest only quarterly payments; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (3.41% at September 30, 2014); due October 26, 2017

     10.0       —    

$70.0 million Second Lien Loan; interest only quarterly payments; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (8.50% at September 30, 2014); due July 28, 2020

     70.0       —    

Discount on Second Lien Loan

     (1.7     —    

Promissory notes

     —         1.9  
  

 

 

   

 

 

 
     114.3       46.9  

Current portion of long-term obligations

     (12.0     (13.9
  

 

 

   

 

 

 

Total

   $ 102.3     $ 33.0  
  

 

 

   

 

 

 

Our weighted average interest rate for our five year $60.0 million Term Loan under our existing senior secured Credit Agreement was 3.4% for the three and nine-month periods ended September 30, 2014, as compared to 2.7% for the three and nine-month periods ended September 30, 2013.

On July 28, 2014, we entered into a Second Lien Credit Agreement providing for a term loan in an aggregate principal amount of $70.0 million. The proceeds of $67.4 million were used to pay off a portion of the revolving credit balances under our existing senior secured Credit Agreement dated as of October 26, 2012. Our weighted average interest rate for our Second Lien Loan was 8.5% for the three-month period ended September 30, 2014.

In connection with the Second Lien Credit Agreement, on July 28, 2014, we entered into the fourth amendment to our existing senior secured Credit Agreement, which amends certain covenants, representations and other provisions in our Credit Agreement, to among other things, allow for our entry into the Second Lien Credit Agreement. The fourth amendment also decreases the aggregate principal amount of the revolving credit facility under our existing senior secured Credit Agreement from up to $165.0 million to up to $120.0 million.

Our existing senior secured Credit Agreement, as amended on July 28, 2014, limits total leverage, senior secured leverage and requires minimum coverage of fixed charges. As of September 30, 2014, our total leverage ratio was 2.1, our senior secured leverage was 1.2 and our fixed charge coverage ratio was 1.8 and we are in compliance with the existing senior secured Credit Agreement. We currently anticipate we will be in compliance with the covenants associated with our long-term obligations over the next 12 months. In the event we are not in compliance with our debt covenants in the future, we would pursue various alternatives in an attempt to successfully resolve the non-compliance, which might include, among other things, seeking debt covenant waivers or amendments.

 

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NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

 

As of the date of this filing, our availability under our $120.0 million Revolving Credit Facility, as amended by the fourth amendment to our existing senior secured Credit Agreement, was $55.7 million and we had $19.3 million outstanding in letters of credit.

6. COMMITMENTS AND CONTINGENCIES

Legal Proceedings

We are involved in the following legal actions:

United States Senate Committee on Finance Inquiry

On May 12, 2010, we received a letter of inquiry from the Senate Finance Committee requesting documents and information relating to our policies and practices regarding home therapy visits and therapy utilization trends. A similar letter was sent to the other major publicly traded home health care companies. We cooperated with the Committee with respect to this inquiry.

On October 3, 2011, the Committee publicly issued a report titled “Staff Report on Home Health and the Medicare Therapy Threshold.” The Committee recommended that the CMS “must move toward taking therapy out of the payment model.” We believe that the issuance of the report concludes the Committee’s inquiry, but are not in a position to speculate on the potential for future legislative or oversight action by the Committee.

Securities Class Action Lawsuits

On June 10, 2010, a putative securities class action complaint was filed in the United States District Court for the Middle District of Louisiana (the “District Court”) against the Company and certain of our current and former senior executives. Additional putative securities class actions were filed in the Court on July 14, July 16, and July 28, 2010.

On October 22, 2010, the District Court issued an order consolidating the putative securities class action lawsuits and the Federal Derivative Actions (described immediately below) for pre-trial purposes. In the same order, the District Court appointed the Public Employees Retirement System of Mississippi and the Puerto Rico Teachers’ Retirement System as co-lead plaintiffs (together, the “Co-Lead Plaintiffs”) for the putative class. On December 10, 2010, the District Court also consolidated the ERISA class action lawsuit (described below) with the putative securities class actions and Federal Derivative Actions for pre-trial purposes.

On January 18, 2011, the Co-Lead Plaintiffs filed an amended, consolidated class action complaint (the “Securities Complaint”) which supersedes the earlier-filed securities class action complaints. The Securities Complaint alleges that the defendants made false and/or misleading statements and failed to disclose material facts about our business, financial condition, operations and prospects, particularly relating to our policies and practices regarding home therapy visits under the Medicare home health prospective payment system and the related alleged impact on our business, financial condition, operations and prospects. The Securities Complaint seeks a determination that the action may be maintained as a class action on behalf of all persons who purchased the Company’s securities between August 2, 2005 and September 28, 2010 and an unspecified amount of damages.

All defendants moved to dismiss the Securities Complaint. On June 28, 2012, the District Court granted the defendants’ motion to dismiss the Securities Complaint. On July 26, 2012, the Co-Lead Plaintiffs filed a motion for reconsideration, which the District Court denied on April 9, 2013.

On May 3, 2013, the Co-Lead Plaintiffs appealed the dismissal of the Securities Complaint to the United States Court of Appeals for the Fifth Circuit (the “Fifth Circuit”). On October 2, 2014, a three-judge panel of the Fifth Circuit issued a decision reversing the District Court’s dismissal of the Securities Complaint. On October 16, 2014, all defendants filed a petition with the Fifth Circuit to review the three-judge panel’s decision en banc, or as a whole court. No assurances can be given as to the timing or outcome of the defendants’ petition for en banc rehearing.

ERISA Class Action Lawsuit

On September 27, 2010 and October 22, 2010, separate putative class action complaints were filed in the United States District Court for the Middle District of Louisiana against the Company, certain of our current and former senior executives and members of our 401(k) Plan Administrative Committee. The suits alleged violations of the Employee Retirement Income Security Act (“ERISA”) since January 1, 2006 and July 1, 2007, respectively. The plaintiffs brought the complaints on behalf of themselves and a class of similarly situated participants in our 401(k) Plan. The plaintiffs asserted that the defendants breached their fiduciary duties to the 401(k) Plan’s participants by causing the 401(k) Plan to offer and hold Amedisys common stock during the respective class periods when it was an allegedly unduly risky and imprudent retirement investment because of our alleged improper business practices. The complaints sought a determination that the actions may be maintained as a class action, an award of unspecified monetary damages and other unspecified relief. As noted above, on December 10, 2010, the Court consolidated the putative ERISA class actions with the putative securities class actions and derivative actions for pre-trial purposes. In addition, on December 10, 2010, the Court appointed interim lead counsel and interim liaison counsel in the ERISA class action.

 

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(Unaudited)

 

On March 10, 2011, Wanda Corbin, Pia Galimba and Linda Trammell (the “Co-ERISA Plaintiffs”), filed an amended, consolidated class action complaint (the “ERISA Complaint”), which superseded the earlier-filed ERISA class action complaints. The ERISA Complaint sought a determination that the action may be maintained as a class action on behalf of themselves and a class of similarly situated participants in our 401(k) plan from January 1, 2008 through present. All of the defendants moved to dismiss the ERISA Complaint.

On November 5, 2013, we reached an agreement in principle to settle the ERISA class action lawsuits on a class-wide basis under which we would make a payment of $1.2 million (which we correctly anticipated would be paid by our insurance carrier) and provide additional non-monetary benefits to 401(k) Plan participants. We then negotiated a formal settlement agreement with the Co-ERISA Plaintiffs and on December 13, 2013, submitted it to the Court for preliminary and final approval. The formal settlement agreement described how the $1.2 million settlement payment would be allocated among the putative class of 401(k) Plan participants after certain expenses and fees were deducted. On April 14, 2014, the Court granted the motion for preliminary approval and scheduled a final fairness hearing for July 22, 2014. Our insurance carrier funded the $1.2 million settlement pool shortly after the entry of the April 14, 2014 order.

On July 22, 2014, the Court conducted a fairness hearing. On July 24, 2014, the Court entered an order approving the settlement, dismissing the ERISA class action lawsuits with prejudice, certifying a settlement class and approving the release of all claims by the settlement class that were or could have been alleged in the matter.

SEC Investigation

On June 30, 2010, we received notice of a formal investigation from the SEC and received a subpoena for documents relating to the matters under review by the United States Senate Committee on Finance and other matters involving our operations. We cooperated with the SEC with respect to this investigation, and in June 2014 we were informed by the SEC staff that the investigation had been completed and that the staff did not intend to recommend any enforcement action by the SEC.

U.S. Department of Justice Civil Investigative Demand (“CID”) Pursuant to False Claims Act and Stark Law Matters

On September 27, 2010, we received a CID issued by the U.S. Department of Justice pursuant to the federal False Claims Act. The CID requires the delivery of a wide range of documents and information relating to the Company’s clinical and business operations, including reimbursement and billing claims submitted to Medicare for home health services, and related compliance activities. The CID generally covers the period from January 1, 2003. On April 26, 2011, we received a second CID related to the CID issued in September 2010, which generally covers the same time period as the previous CID and requires the production of additional documents. Such CIDs are often associated with previously filed qui tam actions, or lawsuits filed under seal under the False Claims Act (“FCA”), 31 U.S.C. § 3729 et seq. Qui tam actions are brought by private plaintiffs suing on behalf of the federal government for alleged FCA violations. Subsequently, the Company and certain current and former employees received additional CIDs for additional documents and/or testimony.

In May 2012, we made a disclosure to CMS under the agency’s Stark Law Self-Referral Disclosure Protocol relating to certain services agreements between a subsidiary of ours and a large physician group. During some period of time since December 2007, the arrangements appear not to have complied in certain respects with an applicable exemption to the Stark Law referral prohibition. Medicare revenue earned as a result of referrals from the physician group from May 2008 to May 2012, the relevant four year “lookback” period under the Stark Law Self-Referral Disclosure Protocol, was approximately $4 million. On January 11, 2013, one of our subsidiaries received a CID from the United States Attorney’s Office for the Northern District of Georgia seeking certain information relating to that subsidiary’s relationship with this physician group.

On October 4, 2013, we reached an agreement in principle to resolve both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter. We agreed to this tentative settlement without any admission of wrongdoing to resolve these matters and to avoid the uncertainty and expense of protracted litigation. On April 23, 2014, we entered into a settlement agreement to resolve both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter. The settlement agreement contains no admissions of liability on our part.

Pursuant to the settlement agreement, on May 2, 2014, we paid the United States an initial payment in the amount of $116.5 million, representing the first installment of $115 million plus interest thereon due under the settlement agreement, and on October 23, 2014, we paid the United States an additional payment in the amount of $35.8 million, representing the second and final installment of $35 million plus interest thereon due under the settlement agreement.

In consideration of our obligations under the settlement agreement and conditioned upon our full payment of the settlement amount, the United States agreed to release us from any civil or administrative monetary claim under the False Claims Act and various other statutes and legal theories for (a) claims involving home health services rendered by certain of our care centers from January 1, 2008 through December 31, 2010 that the United States contended were (i) provided to patients who were not homebound, (ii) provided to patients lacking a need for skilled nursing and/or skilled therapy services, (iii) provided to patients without regard to medical

 

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AMEDISYS, INC. AND SUBSIDIARIES

NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

 

necessity, or (iv) overbilled by upcoding patients’ diagnoses, and (b) claims arising from our billings to the Medicare program during the period from April 1, 2008 through April 30, 2012 for home health services referred by a particular physician practice group while we were providing such practice group remuneration that was not consistent with fair market value in the form of patient care coordination services performed by our employees.

The settlement agreement also resolved allegations made against us by various qui tam relators, who were required to dismiss their claims with prejudice. We were required to pay various relators’ attorneys’ fees and expenses in the aggregate sum of approximately $3.9 million. In addition, we will incur additional expenses in the future in connection with compliance measures mandated by the corporate integrity agreement discussed below.

We have previously recorded an accrual for the settlement amount and added the amount of the relators’ attorneys’ fees to this accrual in the quarter ended March 31, 2014.

In connection with the settlement agreement, on April 23, 2014, we entered into a corporate integrity agreement with the Office of Inspector General-HHS. The corporate integrity agreement formalizes various aspects of our already existing ethics and compliance programs and contains other requirements designed to help ensure our ongoing compliance with federal health care program requirements. Among other things, the corporate integrity agreement requires us to maintain our existing compliance program and compliance committee; provide certain compliance training; continue screening new and current employees against certain lists to ensure they are not ineligible to participate in federal health care programs; engage an independent review organization to perform certain auditing and reviews and prepare certain reports regarding our compliance with federal health care programs, our billing submissions to federal health care programs and our compliance and risk mitigation programs; and provide certain reports and management certifications to Office of Inspector General-HHS. Upon breach of the corporate integrity agreement, we could become liable for payment of certain stipulated penalties, or could be excluded from participation in federal health care programs. The corporate integrity agreement has a term of five years.

OIG Self-Disclosure

In October 2012, we made a disclosure to the Office of Counsel to the Inspector General of the United States Department of Health and Human Services (the “OIG”) pursuant to the OIG Provider Self-Disclosure Protocol regarding certain clinical documentation issues and eligibility regulatory requirements at two of our hospice care centers. These hospice care centers did not comply in some respects with certain state and Medicare hospice regulations including those requiring physicians to certify patient eligibility and requiring patient face-to-face encounters. We recorded an additional accrual of approximately $1 million during the three-month period ended September 30, 2013 increasing the total accrual to approximately $2 million as of September 30, 2013, where it remained at December 31, 2013. A final settlement agreement with OIG, pursuant to which we agreed to pay approximately $2 million to settle the matter, was executed on March 12, 2014.

In September and October 2013, we made preliminary disclosures to OIG under the OIG’s Provider Self-Disclosure Protocol regarding certain clinical documentation issues at one of our home health care centers. This care center appears to have not complied with certain Medicare home health regulations, including those relating to physician signature requirements and face-to-face documentation. We made a disclosure in March 2014 to OIG providing additional information relating to the information disclosed in the preliminary disclosures sent in September and October 2013. As of June 30, 2014, we had recorded an accrual of approximately $1.9 million for this matter. A final settlement agreement with OIG pursuant to which we agreed to pay approximately $2.1 million to settle the matter was executed on September 9, 2014.

Wage and Hour Litigation

On July 25, 2012, a putative collective and class action complaint was filed in the United States District Court for the District of Connecticut against us in which three former employees allege wage and hour law violations. The former employees claim that they were not paid overtime for all hours worked over forty hours in violation of the Federal Fair Labor Standards Act (“FLSA”), as well as the Pennsylvania Minimum Wage Act. More specifically, they allege they were paid on both a per-visit and an hourly basis, and that such a pay scheme resulted in their misclassification as exempt employees, thereby denying them overtime pay. Moreover, in response to a Company motion arguing that plaintiffs’ complaint was deficient in that it was ambiguous and failed to provide fair notice of the claims asserted and plaintiffs’ opposition thereto, the Court, on April 8, 2013, held that the complaint adequately raises general allegations that the plaintiffs were not paid overtime for all hours worked in a week over forty, which may include claims for unpaid overtime under other theories of liability, such as alleged off-the-clock work, in addition to plaintiffs’ more clearly stated allegations based on misclassification. On behalf of themselves and a class of current and former employees they allege are similarly situated, plaintiffs seek attorneys’ fees, back wages and liquidated damages going back three years under the FLSA and three years under the Pennsylvania statute. On October 8, 2013, the Court granted plaintiffs’ motion for equitable tolling requesting that the statute of limitations for claims under the FLSA for plaintiffs who opt-in to the lawsuit be tolled from September 24, 2012, the date upon which plaintiffs filed their original motion for conditional certification, until 90 days after any notice of this lawsuit is issued following conditional certification. Following a motion for reconsideration filed by the Company, on December 3, 2013, the Court modified this

 

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AMEDISYS, INC. AND SUBSIDIARIES

NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

 

order, holding that putative class members’ FLSA claims are tolled from October 29, 2012 through the date of the Court’s order on plaintiffs’ motion for conditional certification. On January 13, 2014, the Court granted plaintiffs’ July 10, 2013 motion for conditional certification of their FLSA claims and authorized issuance of notice to putative class members to provide them an opportunity to opt in to the action. On April 17, 2014, that notice was mailed to putative class members. The period within which putative class members were permitted to opt in to the action expired on July 16, 2014.

On September 10, 2014, the plaintiffs in the Connecticut case filed a motion for leave to amend their complaint to add a new claim under the Kentucky Wage and Hour Act (“KWHA”) alleging that the Company did not pay certain home health clinicians working in the Commonwealth of Kentucky all of the overtime wages they were owed, either because the Company misclassified them as exempt from overtime or, while treating them as overtime eligible, did not properly pay them overtime for all hours worked over 40 in a week. On behalf of themselves and a class of current and former employees they allege are similarly situated, plaintiffs seek attorneys’ fees, back wages and liquidated damages going back five years before the filing of their original complaint under the KWHA. On October 1, 2014, the Company filed an opposition to the plaintiffs’ motion to amend. On October 15, 2014, plaintiffs filed a reply brief in support of their motion. The motion is still under consideration by the Court.

On September 13, 2012, a putative collective and class action complaint was filed in the United States District Court for the Northern District of Illinois against us in which a former employee alleges wage and hour law violations. The former employee claims she was paid on both a per-visit and an hourly basis, thereby misclassifying her as an exempt employee and entitling her to overtime pay. The plaintiff alleges violations of Federal and state law and seeks damages under the FLSA and the Illinois Minimum Wage Law. Plaintiff seeks class certification of similar employees who were or are employed in Illinois and seeks attorneys’ fees, back wages and liquidated damages going back three years under the FLSA and three years under the Illinois statute. On May 28, 2013, the Court granted the Company’s motion to stay the case pending resolution of class certification issues and dispositive motions in the earlier-filed Connecticut case referenced above.

We are unable to assess the probable outcome or reasonably estimate the potential liability, if any, arising from the securities and wage and hour litigation described above. The Company intends to continue to vigorously defend itself in the securities and wage and hour litigation matters. No assurances can be given as to the timing or outcome of the securities and wage and hour matters described above or the impact of any of the inquiry or litigation matters on the Company, its consolidated financial condition, results of operations or cash flows, which could be material, individually or in the aggregate.

We recognize that additional putative securities class action complaints and other litigation could be filed, and that other investigations and actions could be commenced.

In addition to the matters referenced in this note, we are involved in legal actions in the normal course of business, some of which seek monetary damages, including claims for punitive damages. We do not believe that these normal course actions, when finally concluded and determined, will have a material impact on our consolidated financial condition, results of operations or cash flows.

Third Party Audits

From time to time, in the ordinary course of business, we are subject to audits under various governmental programs in which third party firms engaged by CMS conduct extensive review of claims data to identify potential improper payments under the Medicare program.

In January 2010, our subsidiary that provides home health services in Dayton, Ohio received from a Medicare Program Safeguard Contractor (“PSC”) a request for records regarding 137 claims submitted by the subsidiary paid from January 2, 2008 through November 10, 2009 (the “Claim Period”) to determine whether the underlying services met pertinent Medicare payment requirements. Based on the PSC’s findings for 114 of the claims, which were extrapolated to all claims for home health services provided by the Dayton subsidiary paid during the Claim Period, on March 9, 2011, the Medicare Administrative Contractor (“MAC”) for the subsidiary issued a notice of overpayment seeking recovery from our subsidiary of an alleged overpayment of approximately $5.6 million. We dispute these findings, and our Dayton subsidiary has filed appeals through the Original Medicare Standard Appeals Process, in which we are seeking to have those findings overturned. Most recently, a consolidated administrative law judge (“ALJ”) hearing was held in late March 2013. In January 2014, the ALJ found fully in favor of our Dayton subsidiary on 74 appeals and partially in favor of our Dayton subsidiary on eight appeals. Taking into account the ALJ’s decision, certain determinations that our Dayton subsidiary decided not to appeal as well as certain determinations made by the MAC, of the 114 claims that were originally extrapolated by the MAC, 76 claims have now been decided in favor of our Dayton subsidiary in full, 10 claims have been decided in favor of our Dayton subsidiary in part, and 28 claims have been decided against or not appealed by our Dayton subsidiary. The ALJ has ordered the MAC to recalculate the extrapolation amount based on the ALJ’s decision. The Medicare Appeals Council can decide on its own motion to review the ALJ’s decisions. As of September 30, 2014, we have recorded no liability with respect to the pending appeals as we do not believe that an estimate of a reasonably possible loss or range of loss can be made at this time.

 

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AMEDISYS, INC. AND SUBSIDIARIES

NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

 

In July 2010, our subsidiary that provides hospice services in Florence, South Carolina received from a Zone Program Integrity Contractor (“ZPIC”) a request for records regarding a sample of 30 beneficiaries who received services from the subsidiary during the period of January 1, 2008 through March 31, 2010 (the “Review Period”) to determine whether the underlying services met pertinent Medicare payment requirements. We acquired the hospice operations subject to this review on August 1, 2009; the Review Period covers time periods both before and after our ownership of these hospice operations. Based on the ZPIC’s findings for 16 beneficiaries, which were extrapolated to all claims for hospice services provided by the Florence subsidiary billed during the Review Period, on June 6, 2011, the MAC for the subsidiary issued a notice of overpayment seeking recovery from our subsidiary of an alleged overpayment. We dispute these findings, and our Florence subsidiary has filed appeals through the Original Medicare Standard Appeals Process, in which we are seeking to have those findings overturned. Most recently, we have requested appeal hearings before an ALJ, which have been scheduled to occur on January 7, 2015, but no assurances can be given as to the timing or outcome of the ALJ appeal. The current alleged extrapolated overpayment is $6.1 million. In the event we pay any amount of this alleged overpayment, we are indemnified by the prior owners of the hospice operations for amounts relating to the period prior to August 1, 2009. As of September 30, 2014, we have recorded no liability for this claim as we do not believe that an estimate of a reasonably possible loss or range of loss can be made at this time.

Insurance

We are obligated for certain costs associated with our insurance programs, including employee health, workers’ compensation and professional liability. While we maintain various insurance programs to cover these risks, we are self-insured for a substantial portion of our potential claims. We recognize our obligations associated with these costs, up to specified deductible limits in the period in which a claim is incurred, including with respect to both reported claims and claims incurred but not reported. These costs have generally been estimated based on historical data of our claims experience. Such estimates, and the resulting reserves, are reviewed and updated by us on a quarterly basis.

Our health insurance has a retention limit of $0.9 million, our workers’ compensation insurance has a retention limit of $0.5 million and our professional liability insurance has a retention limit of $0.3 million.

7. SEGMENT INFORMATION

Our operations involve servicing patients through our two reportable business segments: home health and hospice. Our home health segment delivers a wide range of services in the homes of individuals who may be recovering from surgery, have a chronic disability or terminal illness or need assistance with the essential activities of daily living. Our hospice segment provides palliative care and comfort to terminally ill patients and their families. The “other” column in the following tables consists of costs relating to corporate support functions that are not directly attributable to a specific segment.

Management evaluates performance and allocates resources based on the operating income of the reportable segments, which includes an allocation of corporate expenses directly attributable to the specific segment and includes revenues and all other costs directly attributable to the specific segment. Corporate expenses consist of cost relating to our executive management and corporate and administrative support functions that are not directly attributable to a specific segment. Corporate and administrative support functions represent primarily information services, accounting, finance, billing and collections, legal, compliance, risk management, procurement, marketing, clinical administration, training, human resources and administration. Segment assets are not reviewed by the company’s chief operating decision maker and therefore are not disclosed below (amounts in millions).

 

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AMEDISYS, INC. AND SUBSIDIARIES

NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

 

     For the Three-Month Period Ended September 30, 2014  
     Home Health      Hospice      Other     Total  

Net service revenue

   $ 237.2      $ 63.1      $ —       $ 300.3  

Cost of service, excluding depreciation and amortization

     137.4        32.8        —         170.2  

General and administrative expenses

     63.1         14.1        26.0       103.2  

Provision for doubtful accounts

     4.1        0.1        —         4.2  

Depreciation and amortization

     2.1        0.5        3.9       6.5  
  

 

 

    

 

 

    

 

 

   

 

 

 

Operating expenses

     206.7        47.5        29.9       284.1  
  

 

 

    

 

 

    

 

 

   

 

 

 

Operating income (loss)

   $ 30.5      $ 15.6      $ (29.9   $ 16.2  
  

 

 

    

 

 

    

 

 

   

 

 

 
     For the Three-Month Period Ended September 30, 2013  
     Home Health      Hospice      Other     Total  

Net service revenue

   $ 236.8      $ 64.5      $ —       $ 301.3  

Cost of service, excluding depreciation and amortization

     140.7        34.5        —         175.2  

General and administrative expenses

     74.3        16.1        25.6       116.0  

Provision for doubtful accounts

     2.7        1.2        —         3.9  

Depreciation and amortization

     2.5        0.5        5.9       8.9  

U.S. Department of Justice settlement

     —          —          150.0       150.0  

Other intangibles impairment charge

     1.5        —          —         1.5  
  

 

 

    

 

 

    

 

 

   

 

 

 

Operating expenses

     221.7        52.3        181.5       455.5  
  

 

 

    

 

 

    

 

 

   

 

 

 

Operating income (loss)

   $ 15.1      $ 12.2      $ (181.5   $ (154.2
  

 

 

    

 

 

    

 

 

   

 

 

 
     For the Nine-Month Period Ended September 30, 2014  
     Home Health      Hospice      Other     Total  

Net service revenue

   $ 717.4      $ 186.6      $ —       $ 904.0  

Cost of service, excluding depreciation and amortization

     420.7        99.0        —         519.7  

General and administrative expenses

     206.4        44.3        86.8       337.5  

Provision for doubtful accounts

     11.8        1.5        —         13.3  

Depreciation and amortization

     7.0        1.6        13.5       22.1  

Other intangibles impairment charge

     1.2        1.0        —         2.2  
  

 

 

    

 

 

    

 

 

   

 

 

 

Operating expenses

     647.1        147.4        100.3       894.8  
  

 

 

    

 

 

    

 

 

   

 

 

 

Operating income (loss)

   $ 70.3      $ 39.2      $ (100.3   $ 9.2  
  

 

 

    

 

 

    

 

 

   

 

 

 
     For the Nine-Month Period Ended September 30, 2013  
     Home Health      Hospice      Other     Total  

Net service revenue

   $ 749.3      $ 196.5      $ —       $ 945.8  

Cost of service, excluding depreciation and amortization

     434.5        104.2        —         538.7  

General and administrative expenses

     230.4        49.2        77.6       357.2  

Provision for doubtful accounts

     7.6        4.8        —         12.4  

Depreciation and amortization

     7.8        1.6        18.9       28.3  

U.S. Department of Justice settlement

     —          —          150.0       150.0  

Other intangibles impairment charge

     3.8        —          —         3.8  
  

 

 

    

 

 

    

 

 

   

 

 

 

Operating expenses

     684.1        159.8        246.5       1,090.4  
  

 

 

    

 

 

    

 

 

   

 

 

 

Operating income (loss)

   $ 65.2      $ 36.7      $ (246.5   $ (144.6
  

 

 

    

 

 

    

 

 

   

 

 

 

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

The following discussion and analysis provides information we believe is relevant to an assessment and understanding of our results of operations and financial condition for the three and nine-month period ended September 30, 2014. This discussion should be read in conjunction with the condensed consolidated financial statements and notes thereto included herein, and the consolidated financial statements and notes and the related Management’s Discussion and Analysis of Financial Condition and Results of Operations in our Annual Report on Form 10-K for the year ended December 31, 2013 filed with the Securities and Exchange Commission (“SEC”) on March 12, 2014 (the “Form 10-K”), which are incorporated herein by this reference.

Unless otherwise provided, “Amedisys,” “we,” “our,” and the “Company” refer to Amedisys, Inc. and our consolidated subsidiaries.

Overview

We are a leading provider of high-quality, low-cost home health services to the chronic, co-morbid, aging American population with approximately 81% and 84% of our revenue derived from Medicare for the three-month periods ended September 30, 2014 and 2013, respectively, and approximately 82% and 84% of our revenue derived from Medicare for the nine-month periods ended September 30, 2014 and 2013, respectively.

Our operations involve servicing patients through our two reportable business segments: home health and hospice. Our home health segment delivers a wide range of services in the homes of individuals who may be recovering from an illness, injury or surgery. Our hospice segment provides care that is designed to provide comfort and support for those who are facing a terminal illness. As of September 30, 2014, we owned and operated 316 Medicare-certified home health care centers and 80 Medicare-certified hospice care centers in 34 states within the United States, the District of Columbia and Puerto Rico.

As part of our ongoing management of our portfolio of care centers, we review each care center’s current financial performance, market penetration, forecasted market growth and the impact of proposed CMS payment revisions. Therefore, during the three months ended March 31, 2014, we consolidated four home health care centers with care centers servicing the same markets, closed four home health care centers and one hospice care center and sold one home health care center. During the three months ended June 30, 2014, we consolidated 18 home health care centers and four hospice care centers with care centers servicing the same markets, closed 18 home health care centers and three hospice care centers and sold six home health care centers and four hospice care centers. During the three months ended September 30, 2014, we exited our one hospice inpatient unit.

In connection with the care centers that we closed and consolidated, we recorded non-cash charges of $2.2 million in other intangibles impairment expense related to the write-off of intangible assets, $2.1 million in other general and administrative expenses related to lease termination costs and $2.1 million in salaries and benefits related to severance costs during the three-month period ended March 31, 2014.

In conjunction with the closure and consolidation of care centers, we restructured our regional leadership and corporate support functions. As such, we recorded charges of $3.4 million in salaries and benefits related to severance costs during the three-month period ended March 31, 2014. In addition, on February 20, 2014 William F. Borne stepped down from his positions as Chief Executive Officer, Chairman and a member of our Board of Directors and we recorded charges of $2.3 million in salaries and benefits related to severance costs.

Owned and Operated Care Centers

 

     Home Health     Hospice  

At December 31, 2013

     367       92  

Closed/Consolidated/Sold

     (51     (12
  

 

 

   

 

 

 

At September 30, 2014

     316       80  
  

 

 

   

 

 

 

Recent Developments

Governmental Inquiries and Investigations and Other Litigation

On April 23, 2014, we entered into a settlement agreement to resolve both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter. Pursuant to the settlement agreement, on May 2, 2014, we paid the United States an initial payment in the amount of $116.5 million representing the first installment of $115 million plus interest thereon due under the settlement agreement, and on October 23, 2014, we paid the United States an additional payment in the amount of $35.8 million, representing the second and final installment of $35 million plus interest thereon due under the settlement agreement.

 

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The settlement agreement also resolves allegations made against us by various qui tam relators, who are required to dismiss their claims with prejudice. We accrued various relators’ attorneys’ fees and expenses in the aggregate sum of approximately $3.9 million during the three months ended March 31, 2014, which were paid on May 2, 2014.

In connection with the settlement agreement, on April 23, 2014, we entered into a corporate integrity agreement with the Office of Inspector General-HHS. The corporate integrity agreement formalizes various aspects of our already existing ethics and compliance programs and contains other requirements designed to help ensure our ongoing compliance with federal health care program requirements. Among other things, the corporate integrity agreement requires us to maintain our existing compliance program and compliance committee; provide certain compliance training; continue screening new and current employees against certain lists to ensure they are not ineligible to participate in federal health care programs; engage an independent review organization to perform certain auditing and reviews and prepare certain reports regarding our compliance with federal health care programs, our billing submissions to federal health care programs and our compliance and risk mitigation programs; and provide certain reports and management certifications to Office of Inspector General-HHS. Upon breach of the corporate integrity agreement, we could become liable for payment of certain stipulated penalties, or could be excluded from participation in federal health care programs. The corporate integrity agreement has a term of five years. We expect the CIA to impact operating expenses by approximately $1 to $2 million annually beginning in 2015.

See Note 6 – Commitments and Contingencies to our condensed consolidated financial statements for additional information regarding the U.S. Department of Justice settlement, our corporate integrity agreement and for a discussion of and updates regarding the self-disclosure matters and class action litigation we are involved in. No assurances can be given as to the timing or outcome of these items.

Payment

In July 2014, the Centers of Medicare and Medicaid Services (“CMS”) issued a proposed rule to update and revise Medicare home health reimbursement rates for the calendar year 2015. The proposed rule includes a rebasing cut of 2.5% as allowed by the PPACA and the Health Care and Education Reconciliation Act of 2010 and a negative multifactor productivity adjustment of 0.4% offset by a 2.6% market basket increase. CMS estimates that the net effect of these changes is approximately a 0.3% decrease in reimbursement to home health providers. Our impact could differ depending on differences in the wage index and the impact of coding changes. We expect CMS to issue a final rule during the fourth quarter of 2014.

In August 2014, CMS issued a final rule to update the Medicare hospice wage index and Medicare hospice payment rates for fiscal year 2015. The final rule includes a 2.9% market basket update which is reduced by the following: a 0.3% adjustment from the Patient Protection and Affordable Care Act (“PPACA”), a 0.5% productivity adjustment and 0.7% for the updated wage index and budget neutrality adjustment factor. The net effect of the final rule, effective for services provided from October 1, 2014 to September 30, 2015, increases the base rate by 1.4%.

 

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Results of Operations

Three-Month Period Ended September 30, 2014 Compared to the Three-Month Period Ended September 30, 2013

Consolidated

The following table summarizes our consolidated results from continuing operations (amounts in millions):

 

     For the Three-Month Periods Ended
September 30,
 
     2014     2013  

Net service revenue

   $ 300.3     $ 301.3  

Gross margin, excluding depreciation and amortization

     130.1       126.0  

% of revenue

     43.3     41.8

Other operating expenses

     113.9       128.7  

% of revenue

     37.9     42.7

U.S. Department of Justice settlement

     —         150.0  

Other intangibles impairment charge

     —         1.5  
  

 

 

   

 

 

 

Operating income (loss)

     16.2       (154.2
  

 

 

   

 

 

 

Total other (expense) income, net

     (2.3     6.2  

Income tax (expense) benefit

     (5.3     56.9  

Effective income tax rate

     38.4     (38.5 %) 
  

 

 

   

 

 

 

Income (loss) from continuing operations

     8.6       (91.1
  

 

 

   

 

 

 

Net loss from discontinued operations

     —         (0.7

Net (income) loss attributable to noncontrolling interests

     (0.2     0.7  
  

 

 

   

 

 

 

Net income (loss) attributable to Amedisys, Inc.

   $ 8.4     $ (91.1
  

 

 

   

 

 

 

Our operating results have been impacted by the sale, closure and consolidation of 75 care centers since September 30, 2013. Therefore, our consolidated results from continuing operations are not fully comparable to the three-month period ended September 30, 2013.

Our operating income excluding the U.S. Department of Justice settlement and other intangibles impairment charge in 2013, increased $19 million as our home health operating income increased $14 million, our hospice operating income increased $3 million and corporate expenses decreased $2 million. Our home health operating income increased primarily as a result of a decrease in other operating expenses primarily due to closures and the restructure of our regional leadership and corporate support functions.

 

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Home Health Division

The following table summarizes our home health segment results from continuing operations:

 

     For the Three-Month Periods Ended September 30,  
     2014     2013  

Financial Information (in millions):

    

Medicare

   $ 185.4     $ 193.5  

Non-Medicare

     51.8       43.3  
  

 

 

   

 

 

 

Net service revenue

     237.2       236.8  

Cost of service

     137.4       140.7  
  

 

 

   

 

 

 

Gross margin

     99.8       96.1  

Other operating expenses

     69.3       79.5  
  

 

 

   

 

 

 

Operating income before impairment charges (1)

   $ 30.5     $ 16.6  
  

 

 

   

 

 

 

Key Statistical Data:

    

Medicare:

    

Same Store Volume (2):

    

Revenue

     5     (12 %) 

Admissions

     3     (1 %) 

Recertifications

     5     (21 %) 

Total (3):

    

Admissions

     42,389       45,420  

Recertifications

     25,407       26,119  

Completed episodes

     66,906       70,401  

Visits

     1,190,962       1,253,329  

Average revenue per completed episode (4)

   $ 2,834     $ 2,822  

Visits per completed episode (5)

     17.3       17.3  

Non-Medicare:

    

Same Store Volume (2):

    

Revenue

     31     (28 %) 

Admissions

     26     (21 %) 

Recertifications

     24     (33 %) 

Total (3):

    

Admissions

     20,523       17,832  

Recertifications

     8,238       7,262  

Visits

     416,038       358,820  

Total (3):

    

Cost per Visit

   $ 85.47     $ 87.31  

Visits

     1,607,000       1,612,149  

 

(1) Operating income of $15.1 million on a GAAP basis for the three-month period ended September 30, 2013.
(2) Medicare and Non-Medicare revenue, admissions or recertifications same store volume is the percent increase (decrease) in our Medicare and Non-Medicare revenue, admissions or recertifications for the period as a percent of the Medicare and Non-Medicare revenue, admissions or recertifications of the prior period.
(3) Based on continuing operations for all periods presented.
(4) Average Medicare revenue per completed episode is the average Medicare revenue earned for each Medicare completed episode of care which excludes the impact of sequestration.
(5) Medicare visits per completed episode are the home health Medicare visits on completed episodes divided by the home health Medicare episodes completed during the period.

Overall, our operating income before impairment charges (approximately $2 million in 2013) increased $14 million on a $4 million increase in gross margin and a $10 million decline in other operating expenses.

Net Service Revenue

Our Medicare revenue decline of approximately $8 million consisted of $9 million due to lower volumes offset by a $1 million increase related to revenue per episode. The decrease in volumes is primarily due to the sale, closure and consolidation of 60 care centers since September 30, 2013 as we experienced an increase in same store revenue, admissions and recertifications.

 

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Our non-Medicare revenue increased $8 million which is primarily due to increases in volumes and an increase in our revenue per visit. We are experiencing significant growth in our non-Medicare business as we have focused on contract payors with significant concentration in our markets.

As mentioned above, we have closed numerous care centers since September 30, 2013. Accordingly, our results are not fully comparable to prior year. The following table summarizes our net service revenue for our operating care centers and those care centers that were closed, consolidated or sold.

 

     For the Three-Month Periods Ended September 30,  
     2014     2013  

Financial Information (in millions):

    

Operating care centers

   $ 237.5     $ 216.5  

Closed/Consolidated/Sold care centers

     (0.3     20.3  
  

 

 

   

 

 

 

Net service revenue

   $ 237.2     $ 236.8  
  

 

 

   

 

 

 

Cost of Service, Excluding Depreciation and Amortization

Our cost of service decreased $3 million primarily as a result of our decrease in Medicare volumes and a 2% decrease in cost per visit which were offset by a 16% increase in non-Medicare visits. The decrease in cost per visit was the primary reason for our improvement in gross margin as our revenue was relatively flat. The reduction in the number of salaried clinicians was the primary driver in this improvement.

Other Operating Expenses

Our other operating expenses decreased $10 million primarily as the result of a decrease in other care center related expenses due to our closure and consolidation strategy and the reduction in divisional leadership; the majority of the reductions were in salaries and benefits, rent expense and travel costs.

Hospice Division

The following table summarizes our hospice segment results from continuing operations:

 

     For the Three-Month Periods Ended September 30,  
     2014     2013  

Financial Information (in millions):

    

Medicare revenue

   $ 59.0     $ 60.6  

Non-Medicare revenue

     4.1       3.9  
  

 

 

   

 

 

 

Net service revenue

     63.1       64.5  

Cost of service

     32.8       34.5  
  

 

 

   

 

 

 

Gross margin

     30.3       30.0  

Other operating expenses

     14.7       17.8  
  

 

 

   

 

 

 

Operating income

   $ 15.6     $ 12.2  
  

 

 

   

 

 

 

Key Statistical Data:

    

Same store Medicare revenue growth (1)

     3     (13 %) 

Same store Non-Medicare revenue growth (1)

     15     3

Hospice admits

     4,002       4,352  

Average daily census

     4,596       4,917  

Revenue per day

   $ 149.16     $ 142.52  

Cost of service per day

   $ 77.38     $ 75.79  

Average length of stay

     100       98  

 

(1) Same store Medicare and Non-Medicare revenue volume is the percent increase (decrease) in our Medicare and Non-Medicare revenue for the period as a percent of the Medicare and Non-Medicare revenue of the prior period.

Overall, our operating income increased $3 million on a $2 million decline in revenue, a $2 million decline in cost of service and a $3 million decline in other operating expenses.

Net Service Revenue

Our hospice revenue decreased $2 million, primarily as the result of a decrease in our average daily census. The decrease in average daily census is primarily due to the sale, closure and consolidation of 15 care centers since September 30, 2013, the majority of which occurred during the second quarter of 2014. The decrease in revenue was offset by a $2 million decrease in our hospice cap expense as our decline in average daily census and an increase in admissions has resulted in a decrease in our overall cap expense. We benefitted from a 1.0% hospice rate increase effective October 1, 2013.

 

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As mentioned above, we have closed numerous care centers since September 30, 2013. Accordingly, our results are not fully comparable to prior year. The following table summarizes our net service revenue for our operating care centers and those care centers that were closed, consolidated or sold.

 

     For the Three-Month Periods Ended September 30,  
     2014      2013  

Financial Information (in millions):

     

Operating care centers

   $ 63.1      $ 60.1  

Closed/Consolidated/Sold care centers

     —          4.4  
  

 

 

    

 

 

 

Net service revenue

   $ 63.1      $ 64.5  
  

 

 

    

 

 

 

Cost of Service, Excluding Depreciation and Amortization

Our hospice cost of service decreased $2 million, or 5% as the result of a 7% decrease in average daily census offset by an increase in cost of service per day. Our cost per day has been negatively impacted by an increase in pharmacy costs as a result of new CMS guidance which became effective on May 1, 2014.

Other Operating Expenses

Our other operating expenses decreased $3 million primarily due to a decrease in other care center related expenses due to our care center closure and consolidation strategy. The majority of the reductions were in salaries and benefits.

Corporate

The following table summarizes our corporate results from continuing operations:

 

     For the Three-Month Periods Ended September 30,  
     2014      2013  

Financial Information (in millions):

     

Other operating expenses

   $ 26.0      $ 25.6  

Depreciation and amortization

     3.9        5.9  
  

 

 

    

 

 

 

Total before U.S. Department of Justice settlement (1)

   $ 29.9      $ 31.5  
  

 

 

    

 

 

 

 

(1) Total of $181.5 million on a GAAP basis for the three-month period ended September 30, 2013.

Corporate expenses consist of cost relating to our executive management and corporate and administrative support functions that are not directly attributable to a specific segment. Corporate and administrative support functions represent primarily information services, accounting, finance, billing and collections, legal, compliance, risk management, procurement, marketing, clinical administration, training, human resources and administration. During the third quarter of 2013, we recorded an accrual of $150 million and recognized a deferred tax benefit of $56 million for the settlement to resolve both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter. See Note 6 to our consolidated financial statements for additional information.

 

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Nine-Month Period Ended September 30, 2014 Compared to the Nine-Month Period Ended September 30, 2013

Consolidated

The following table summarizes our consolidated results from continuing operations (amounts in millions):

 

     For the Nine-Month Periods Ended
September 30,
 
     2014     2013  

Net service revenue

   $ 904.0     $ 945.8  

Gross margin, excluding depreciation and amortization

     384.3       407.2  

% of revenue

     42.5     43.1

Other operating expenses

     372.9       398.0  

% of revenue

     41.3     42.1

U.S. Department of Justice settlement

     —         150.0  

Other intangibles impairment charge

     2.2       3.8  
  

 

 

   

 

 

 

Operating income (loss)

     9.2       (144.6
  

 

 

   

 

 

 

Total other (expense) income, net

     (2.8     4.7  

Income tax (expense) benefit

     (2.5     53.7  

Effective income tax rate

     38.4     (38.4 %) 
  

 

 

   

 

 

 

Income (loss) from continuing operations

     3.9       (86.2
  

 

 

   

 

 

 

Net loss from discontinued operations

     (0.2     (1.6

Net (income) loss attributable to noncontrolling interests

     (0.1     1.2  
  

 

 

   

 

 

 

Net income (loss) attributable to Amedisys, Inc.

   $ 3.6     $ (86.5
  

 

 

   

 

 

 

During the first quarter of 2014, we committed to a plan to consolidate 21 operating home health care centers and four operating hospice care centers with care centers servicing the same markets and close 23 home health care centers and six hospice care centers. As a result of this exit activity, we reduced our regional leadership structure and corporate support functions. Separate from the restructuring costs we also recorded severance costs associated with the departure of our CEO on February 20, 2014. The following details the costs associated with these activities (amounts in millions):

 

     For the Nine Month Period Ended September 30, 2014  
     Home Health      Hospice      Corporate      Total  

Severance (a)

   $ 2.0      $ 0.1      $ —        $ 2.1  

Restructuring severance

     2.1        0.6        3.0        5.7  

Lease terminations

     1.9        0.2        —          2.1  

Other intangibles impairment

     1.2        1.0        —          2.2  
  

 

 

    

 

 

    

 

 

    

 

 

 

Exit and restructuring activities costs

     7.2        1.9        3.0        12.1  

Relator fees

     —          —          3.9        3.9  
  

 

 

    

 

 

    

 

 

    

 

 

 

Total

   $ 7.2      $ 1.9      $ 6.9      $ 16.0  
  

 

 

    

 

 

    

 

 

    

 

 

 

 

(a) Includes $0.8 million and $0.1 million for severance included in cost of service for home health and hospice, respectively.

Our operating results have been impacted by the sale, closure and consolidation of 54 care centers mentioned above as well as the closure of an additional 21 care centers since September 30, 2013. Accordingly, our results for the nine-month period ended September 30, 2014 are not fully comparable to the nine-month period ended September 30, 2013.

Our operating income excluding the $16 million in costs noted above and the U.S. Department of Justice settlement and other intangibles impairment charge in 2013 increased $16 million as our home health operating income increased $9 million, our hospice operating income increased $4 million and corporate expenses decreased $3 million. Additionally, the first quarter of the nine-month period ended September 30, 2013 was not impacted by sequestration as it was not in effect until April 1, 2013. As a result, the nine-month period ended September 30, 2014, was negatively impacted by approximately $3 million.

 

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Home Health Division

The following table summarizes our home health segment results from continuing operations:

 

     For the Nine-Month Periods Ended September 30,  
     2014     2013  

Financial Information (in millions):

    

Medicare

   $ 565.5     $ 610.6  

Non-Medicare

     151.9       138.7  
  

 

 

   

 

 

 

Net service revenue

     717.4       749.3  

Cost of service

     420.7       434.5  
  

 

 

   

 

 

 

Gross margin

     296.7       314.8  

Other operating expenses

     225.2       245.8  
  

 

 

   

 

 

 

Operating income before impairment charges (1)

   $ 71.5     $ 69.0  
  

 

 

   

 

 

 

Key Statistical Data:

    

Medicare:

    

Same Store Volume (2):

    

Revenue

     0     (10 %) 

Admissions

     0     0

Recertifications

     0     (19 %) 

Total (3):

    

Admissions

     132,890       143,161  

Recertifications

     77,468       82,299  

Completed episodes

     204,654       221,746  

Visits

     3,620,779       3,947,351  

Average revenue per completed episode (4)

   $ 2,819     $ 2,810  

Visits per completed episode (5)

     17.2       17.5  

Non-Medicare:

    

Same Store Volume (2):

    

Revenue

     17     (22 %) 

Admissions

     15     (15 %) 

Recertifications

     10     (25 %) 

Total (3):

    

Admissions

     62,447       57,653  

Recertifications

     23,746       22,994  

Visits

     1,218,659       1,161,678  

Total (3):

    

Cost per Visit

   $ 86.92     $ 85.04  

Visits

     4,839,438       5,109,029  

 

(1) Operating income of $70.3 million and $65.2 million on a GAAP basis for the nine-month periods ended September 30, 2014 and 2013, respectively.
(2) Medicare and Non-Medicare revenue, admissions or recertifications volume is the percent increase (decrease) in our Medicare and Non-Medicare revenue, admissions or recertifications for the period as a percent of the Medicare and Non-Medicare revenue, admissions or recertifications of the prior period.
(3) Based on continuing operations for all periods presented.
(4) Average Medicare revenue per completed episode is the average Medicare revenue earned for each Medicare completed episode of care which excludes the impact of sequestration.
(5) Medicare visits per completed episode are the home health Medicare visits on completed episodes divided by the home health Medicare episodes completed during the period.

Overall, our operating income excluding $7 million in exit activity costs in 2014, increased $9 million on a $32 million decline in revenue. The 2% sequestration reduction was effective April 1, 2013; accordingly, the nine-month period ended September 30, 2013 benefitted by approximately $2 million. Medicare revenue was impacted by lower volumes offset by a $15 million decrease in cost of service and a $26 million decrease in other operating expenses.

 

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Net Service Revenue

Our Medicare revenue decline of approximately $45 million consisted of $45 million due to lower volumes and $2 million due to sequestration, partially offset by higher revenue per episode. The volume decline is due to declines in both admissions and recertifications, primarily as the result of the sale, closure and consolidation of 60 care centers since September 30, 2013, the majority of which occurred during the second quarter of 2014.

Our non-Medicare revenue increased $13 million which is primarily due to a 5% increase in visit volume and a 4% increase in our revenue per visit.

As mentioned above, we have closed numerous care centers since September 30, 2013. Accordingly, our results are not fully comparable to prior year. The following table summarizes our net service revenue for our operating care centers and those care centers that were closed, consolidated or sold.

 

     For the Nine-Month Periods Ended September 30,  
     2014      2013  

Financial Information (in millions):

     

Operating care centers

   $ 701.6      $ 674.8  

Closed/Consolidated/Sold care centers

     15.8        74.5  
  

 

 

    

 

 

 

Net service revenue

   $ 717.4      $ 749.3  
  

 

 

    

 

 

 

Cost of Service, Excluding Depreciation and Amortization

Our cost of service excluding $1 million in exit activity costs in 2014, decreased $15 million primarily as a result of our decrease in volume and a 2% decrease in Medicare visits per episode, offset by a 2% increase in cost per visit and a 5% increase in non-Medicare visits. The increase in cost per visit is the result of wage inflation, an increase in salaried clinicians and the impact of lower visits due to the fixed nature of some of our care delivery costs. We have seen improvement in our cost per visit metric in the second and third quarters of 2014.

Other Operating Expenses

Other operating expenses excluding $6 million in exit activity costs in 2014, decreased $26 million with $13 million attributed primarily to salary and wages. The remaining $13 million is primarily the result of reductions in facilities and travel expenses and other care center related costs, offset by an increase in our provision for doubtful accounts which is reflective of our increase in non-Medicare revenue and our higher percentage of contracted payors. Our strategy to consolidate care centers within overlapping markets was a major factor in this decrease.

 

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Hospice Division

The following table summarizes our hospice segment results from continuing operations:

 

     For the Nine-Month Periods Ended September 30,  
     2014     2013  

Financial Information (in millions):

    

Medicare revenue

   $ 175.1     $ 185.0  

Non-Medicare revenue

     11.5       11.5  
  

 

 

   

 

 

 

Net service revenue

     186.6       196.5  

Cost of service

     99.0       104.2  
  

 

 

   

 

 

 

Gross margin

     87.6       92.3  

Other operating expenses

     47.4       55.6  
  

 

 

   

 

 

 

Operating income before impairment charges (1)

   $ 40.2     $ 36.7  
  

 

 

   

 

 

 

Key Statistical Data:

    

Same store Medicare revenue growth (2)

     (2 %)      (10 %) 

Same store Non-Medicare revenue growth (2)

     6     (2 %) 

Hospice admits

     12,947       13,964  

Average daily census

     4,655       4,998  

Revenue per day

   $ 146.85     $ 144.04  

Cost of service per day

   $ 77.70     $ 76.06  

Average length of stay

     100       100  

 

(1) Operating income of $39.2 million on a GAAP basis for the nine-month period ended September 30, 2014.
(2) Same store Medicare and Non-Medicare revenue growth is the percent increase in our Medicare and Non-Medicare revenue for the period as a percent of the Medicare and Non-Medicare revenue of the prior period.

Our operating income, excluding the $2 million in exit activity costs in 2014, increased $4 million primarily as a result of declines in cost of service and other operating expenses. The 2% sequestration reduction was effective April 1, 2013; accordingly the nine-month period ended September 30, 2013 benefitted by approximately $1 million.

Net Service Revenue

Our hospice revenue decreased $10 million, primarily as the result of a decrease in our average daily census and $1 million due to sequestration. The decrease in average daily census is primarily due to the sale, closure and consolidation of 15 care centers since September 30, 2013, the majority of which occurred during the second quarter of 2014. We benefitted from a 1.0% hospice rate increase effective October 1, 2013. Our hospice division also benefitted from a decrease in our provision for estimated revenue adjustments.

As mentioned above, we have closed numerous care centers since September 30, 2013. Accordingly, our results are not fully comparable to prior year. The following table summarizes our net service revenue for our operating care centers and those care centers that were closed, consolidated or sold.

 

     For the Nine-Month Periods Ended September 30,  
     2014      2013  

Financial Information (in millions):

     

Operating care centers

   $ 182.4      $ 182.4  

Closed/Consolidated/Sold care centers

     4.2        14.1  
  

 

 

    

 

 

 

Net service revenue

   $ 186.6      $ 196.5  
  

 

 

    

 

 

 

Cost of Service, Excluding Depreciation and Amortization

Our hospice cost of service decreased $5 million, or 5%, which corresponds to our 7% decrease in average daily census. Our cost per day has been negatively impacted by an increase in pharmacy costs due to new CMS guidance that became effective May 1, 2014.

Other Operating Expenses

Other operating expenses, excluding the $2 million in exit activity costs in 2014, decreased $9 million due to a $3 million decrease in our provision for doubtful accounts and decreases in other care center related expenses due to our care center closure and consolidation strategy.

 

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Corporate

The following table summarizes our corporate results from continuing operations:

 

     For the Nine-Month Periods Ended September 30,  
     2014      2013  

Financial Information (in millions):

     

Other operating expenses

   $ 86.8      $ 77.6  

Depreciation and amortization

     13.5        18.9  
  

 

 

    

 

 

 

Total (1)

   $ 100.3      $ 96.5  
  

 

 

    

 

 

 

 

(1) Total of $246.5 million on a GAAP basis for the nine-month period ended September 30, 2013.

During the third quarter of 2013, we recorded an accrual of $150 million and recognized a deferred tax benefit of $56 million for the settlement to resolve both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter. See Note 6 to our consolidated financial statements for additional information. Excluding the $7 million in exit activity costs in 2014 and the U.S. Department of Justice settlement in 2013, corporate expenses decreased $3 million.

Liquidity and Capital Resources

Cash Flows

The following table summarizes our cash flows for the periods indicated (amounts in millions):

 

     For the Nine-Month Periods Ended
September 30,
 
     2014     2013  

Cash (used in) provided by operating activities

   $ (70.1   $ 93.9  

Cash used in investing activities

     (9.2     (35.5

Cash provided by (used in) financing activities

     67.5       (29.3
  

 

 

   

 

 

 

Net (decrease) increase in cash and cash equivalents

     (11.8     29.1  

Cash and cash equivalents at beginning of period

     17.3       14.5  
  

 

 

   

 

 

 

Cash and cash equivalents at end of period

   $ 5.5     $ 43.6  
  

 

 

   

 

 

 

Cash provided by operating activities decreased $164 million during 2014 compared to 2013 primarily due to the payment of $116.5 million on our settlement agreement with the U.S. Department of Justice and a decline in our operating performance in the first quarter of 2014. Adjusting for the $116.5 million settlement payment, we have generated $46.4 million in cash from operating activities for the nine-months ended September 30, 2014, with $25.3 million generated during the third quarter of 2014. For additional information regarding our operating performance, see “Results of Operations”.

Cash used in investing activities decreased $26.3 million during 2014 compared to 2013 primarily due to decreases in the purchases of property and equipment and investments.

Cash provided by financing activities increased $96.8 million during 2014 compared to 2013 due to an increase in our borrowings on our revolving line of credit and our Second Lien loan. We increased our outstanding long-term obligations net of repayments by $67.4 million from December 31, 2013, primarily to fund the U.S. Department of Justice settlement payment.

Liquidity

Typically, our principal source of liquidity is the collection of our patient accounts receivable, primarily through the Medicare program. During 2014 and 2013, we have experienced reimbursement reductions due to sequestration and the 2014 CMS rate cut, as well as lower recertification volumes which have impacted our business and consolidated financial condition, results of operation and cash flows. In order to mitigate the impact of reimbursement reductions, we have executed a strategy to reduce the number of operating care centers and restructure our regional leadership and corporate support functions. This strategy has improved our operational performance; however, we did incur $12 million in closure and severance related costs which impacted our net income and cash flow. In addition, CMS proposed to reduce reimbursement rates by 2.7% for rebasing in each year from calendar year 2015 to calendar year 2017; however, we do expect some offset from a market basket update. In addition to our collection of patient accounts receivable, from time to time, we can and do obtain additional sources of liquidity by the incurrence of additional indebtedness or through sales of equity.

During the nine-month period ended September 30, 2014, we spent $4.9 million in routine capital expenditures compared to $2.7 million during the nine-month period ended September 30, 2013. Routine capital expenditures primarily include equipment and computer software and hardware. In addition, we spent $5.0 million in non-routine capital expenditures related to enhancements to our

 

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point of care software during the nine-month period ended September 30, 2014, compared to $26.3 million during the nine-month period ended September 30, 2013. The decrease is primarily the result of our nearing completion of our AMS3 development. Our routine and non-routine capital expenditures for 2014 are expected to be approximately $9.1 million and $5.7 million, respectively.

On April 23, 2014, we entered into a settlement agreement to resolve both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter. Pursuant to the settlement agreement, on May 2, 2014, we paid the United States an initial payment in the amount of $116.5 million, representing the first installment of $115 million plus interest thereon due under the settlement agreement, and on October 23, 2014, we paid the United States an additional payment in the amount of $35.8 million, representing the second and final installment of $35 million plus interest thereon due under the settlement agreement.

See Note 6 – Commitments and Contingencies to our condensed consolidated financial statements for additional information regarding the U.S. Department of Justice settlement.

On July 28, 2014, we entered into a Second Lien Credit Agreement providing for a term loan in an aggregate principal amount of $70.0 million and amended our existing senior secured Credit Agreement dated as of October 26, 2012. The proceeds of the Second Lien Credit Agreement were used to pay down a portion of our Revolving Credit Facility.

As of September 30, 2014, we had $5.5 million in cash and cash equivalents and $90.7 million in availability under our $120.0 million Revolving Credit Facility. Based on our operating forecasts, our new debt service requirements and upcoming settlement payment, we believe we will have sufficient liquidity to fund our operations, capital requirements and debt service requirements; however, our ongoing ability to comply with the debt covenants under our credit agreement depends largely on the achievement of adequate levels of operating performance and cash flow. We routinely review our capital requirements to make sure that we have a capital structure in place that meets the current and future needs of the Company. We currently anticipate we will be in compliance with the covenants associated with our long-term obligations over the next 12 months. If our future operating performance and/or cash flows are less than expected, it could cause us to default on our financial covenants in the future. In the event we are not in compliance with our debt covenants in the future, we would pursue various alternatives in an attempt to successfully resolve the non-compliance, which might include, among other things, seeking debt covenant waivers or amendments. There can be no assurance that debt covenant waivers or amendments would be obtained, if needed.

Outstanding Patient Accounts Receivable

Our patient accounts receivable, net decreased $8.3 million from December 31, 2013 to September 30, 2014. Our cash collection as a percentage of revenue was 103% for the nine-month period ended September 30, 2014, and 106% for the nine-month period ended December 31, 2013. Our days revenue outstanding, net has decreased 1.6 days from 32.1 days at December 31, 2013 to 30.5 days at September 30, 2014.

Our patient accounts receivable includes unbilled receivables and are aged based upon our initial service date. At September 30, 2014, our unbilled patient accounts receivable, as a percentage of gross patient accounts receivable, was 32.0%, or $39.0 million, compared to 34.7%, or $44.8 million, at December 31, 2013. We monitor unbilled receivables on a care center by care center basis to ensure that all efforts are made to bill claims within timely filing deadlines. The timely filing deadline for Medicare is one year from the date the episode was completed and varies by state for Medicaid-reimbursable services and among insurance companies and other private payors.

Our provision for estimated revenue adjustments (which is deducted from our service revenue to determine net service revenue) and provision for doubtful accounts were as follows for the periods indicated (amounts in millions). We fully reserve for both our Medicare and other patient accounts receivable that are aged over 365 days.

 

     For the Three-Month Periods Ended
September 30,
    For the Nine-Month Periods Ended
September 30,
 
     2014     2013     2014     2013  

Provision for estimated revenue adjustments (1)

   $ 1.4     $ 2.5     $ 4.1     $ 9.4  

Provision for doubtful accounts (2)

     4.2       4.1       13.4       12.8  
  

 

 

   

 

 

   

 

 

   

 

 

 

Total

   $ 5.6     $ 6.6     $ 17.5     $ 22.2  
  

 

 

   

 

 

   

 

 

   

 

 

 

As a percent of revenue

     1.9     2.2     1.9     2.3
  

 

 

   

 

 

   

 

 

   

 

 

 

 

(1) Includes $0.1 million and $0.3 million from discontinued operations for the nine-months ended September 30, 2014 and 2013, respectively.
(2) Includes $0.2 million from discontinued operations for the three-months ended September 30, 2013. Includes $0.1 million and $0.4 million from discontinued operations for the nine-months ended September 30, 2014 and 2013, respectively.

 

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The following schedules detail our patient accounts receivable, net of estimated revenue adjustments, by payor class, aged based upon initial date of service (amounts in millions, except days revenue outstanding, net):

 

     0-90      91-180      181-365      Over 365      Total  

At September 30, 2014:

              

Medicare patient accounts receivable, net (1)

   $ 60.4      $ 7.6      $ 0.6      $ —        $ 68.6  
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

 

Other patient accounts receivable:

              

Medicaid

     9.3        1.8        1.2        0.4         12.7  

Private

     24.8        5.8        3.8        2.8        37.2  
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

 

Total

   $ 34.1      $ 7.6      $ 5.0      $ 3.2      $ 49.9  
  

 

 

    

 

 

    

 

 

    

 

 

    

Allowance for doubtful accounts (2)

                 (15.6
              

 

 

 

Non-Medicare patient accounts receivable, net

               $ 34.3  
              

 

 

 

Total patient accounts receivable, net

               $ 102.9  
              

 

 

 

Days revenue outstanding, net (3)

                 30.5  
              

 

 

 

 

     0-90      91-180      181-365      Over 365      Total  

At December 31, 2013:

              

Medicare patient accounts receivable, net (1)

   $ 66.7      $ 8.7      $ —        $ —        $ 75.4  
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

 

Other patient accounts receivable:

              

Medicaid

     11.4        2.6        1.3        0.3        15.6  

Private

     19.8        8.0        3.9        2.6        34.3  
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

 

Total

   $ 31.2      $ 10.6      $ 5.2      $ 2.9      $ 49.9  
  

 

 

    

 

 

    

 

 

    

 

 

    

Allowance for doubtful accounts (2)

                 (14.2
              

 

 

 

Non-Medicare patient accounts receivable, net

               $ 35.7  
              

 

 

 

Total patient accounts receivable, net

               $ 111.1  
              

 

 

 

Days revenue outstanding, net (3)

                 32.1  
              

 

 

 

 

(1) The following table summarizes the activity and ending balances in our estimated revenue adjustments (amounts in millions), which is recorded to reduce our Medicare outstanding patient accounts receivable to their estimated net realizable value, as we do not estimate an allowance for doubtful accounts for our Medicare claims.

 

    For the Three-Month
Period Ended

September 30, 2014
    For the Three-Month
Period Ended
December 31, 2013
    For the Nine-Month
Period Ended

September 30, 2014
    For the Nine-Month
Period Ended
December 31, 2013
 

Balance at beginning of period

  $ 3.7     $ 6.0     $ 3.9     $ 7.1  

Provision for estimated revenue adjustments (a)

    1.4       —         4.1       5.4  

Write offs

    (1.5     (2.1     (4.4     (8.6
 

 

 

   

 

 

   

 

 

   

 

 

 

Balance at end of period

  $ 3.6     $ 3.9     $ 3.6     $ 3.9  
 

 

 

   

 

 

   

 

 

   

 

 

 

 

(a) Includes $0.1 million from discontinued operations for the three-month period ended December 31, 2013. Includes $0.1 million and $0.3 million from discontinued operations for the nine-month periods ended September 30, 2014 and December 31, 2013, respectively.

Our estimated revenue adjustments were 4.9% of our outstanding Medicare patient accounts receivable at September 30, 2014 and December 31, 2013.

 

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Table of Contents
(2) The following table summarizes the activity and ending balances in our allowance for doubtful accounts (amounts in millions), which is recorded to reduce only our Medicaid and private payer outstanding patient accounts receivable to their estimated net realizable value.

 

     For the Three-Month
Period Ended
September 30, 2014
    For the Three-Month
Period Ended
December 31, 2013
    For the Nine-Month
Period Ended
September 30, 2014
    For the Nine-Month
Period Ended
December 31, 2013
 

Balance at beginning of period

   $ 14.9     $ 15.6     $ 14.2     $ 19.0  

Provision for doubtful accounts (a)

     4.2       3.6       13.4       12.5  

Write offs

     (3.5     (5.0     (12.0     (17.3
  

 

 

   

 

 

   

 

 

   

 

 

 

Balance at end of period

   $ 15.6     $ 14.2     $ 15.6     $ 14.2  
  

 

 

   

 

 

   

 

 

   

 

 

 

 

(a) Includes $0.2 million from discontinued operations for the three-month periods ended December 31, 2013. Includes $0.1 million and $0.5 million from discontinued operations for the nine-month periods ended September 30, 2014 and December 31, 2013, respectively.

Our allowance for doubtful accounts was 31.3% and 28.5% of our outstanding Medicaid and private patient accounts receivable at September 30, 2014 and December 31, 2013, respectively.

 

(3) Our calculation of days revenue outstanding, net is derived by dividing our ending net patient accounts receivable (i.e., net of estimated revenue adjustments and allowance for doubtful accounts) at September 30, 2014 and December 31, 2013 by our average daily net patient revenue for the three-month periods ended September 30, 2014 and December 31, 2013, respectively.

Indebtedness

Our weighted average interest rate for our five year $60.0 million Term Loan was 3.4% for the three and nine-month periods ended September 30, 2014, as compared to 2.7% for the three and nine-month periods ended September 30, 2013.

As of September 30, 2014, our total leverage ratio was 2.1, our senior secured leverage ratio was 1.2, our fixed charge coverage ratio was 1.8, and we were in compliance with the covenants associated with our long-term obligations.

On July 28, 2014, we entered into a Second Lien Credit Agreement providing for a term loan in an aggregate principal amount of $70.0 million and amended our existing senior secured Credit Agreement dated as of October 26, 2012. The proceeds of the Second Lien Credit Agreement were used to pay down a portion of our Revolving Credit Facility. Our weighted average interest rate for our Second Lien Loan was 8.5% for the three months ended September 30, 2014.

As of the date of this filing, our availability under our $120.0 million Revolving Credit Facility, as amended by the fourth amendment to our existing senior secured Credit Agreement was $55.7 million and we had $19.3 million outstanding in letters of credit.

See Note 7 of the financial statements included in our Form 10-K for additional details on our outstanding long-term obligations which were outstanding as of December 31, 2013.

Inflation

We do not believe inflation has significantly impacted our results of operations.

Critical Accounting Policies

See Part II, Item 7 – Critical Accounting Policies and our consolidated financial statements and related notes in Part IV, Item 15 of our 2013 Annual Report on Form 10-K, for accounting policies and related estimates we believe are the most critical to understanding our condensed consolidated financial statements, financial condition and results of operations and which require complex management judgment and assumptions, or involve uncertainties. These critical accounting policies include revenue recognition; patient accounts receivable; insurance; goodwill and intangible assets; and income taxes. There have not been any changes to our significant accounting policies or their application since we filed our 2013 Annual Report on Form 10-K. See Note 2 – Summary of Significant Accounting Policies to our condensed consolidated financial statements for information pertaining to accounting changes effective in 2014 and for information on issued accounting pronouncements that will be effective in future periods.

ITEM 3. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

We are exposed to market risk from fluctuations in interest rates. Our Revolving Credit Facility and Term Loan carry a floating interest rate which is tied to the Eurodollar rate (i.e. LIBOR) and the Prime Rate and therefore, our condensed consolidated statements of operations and our condensed consolidated statements of cash flows will be exposed to changes in interest rates. As of September 30, 2014, the total amount of outstanding debt subject to interest rate fluctuations was $116.0 million. A 1.0% interest rate change would cause interest expense to change by approximately $1.2 million annually.

 

30


Table of Contents

ITEM 4. CONTROLS AND PROCEDURES

Evaluation of Disclosure Controls and Procedures

We have established disclosure controls and procedures which are designed to provide reasonable assurance of achieving their objectives and to ensure that information required to be disclosed in our reports filed under the Exchange Act is recorded, processed, summarized, disclosed and reported within the time periods specified in the SEC’s rules and forms. This information is also accumulated and communicated to our management and Board of Directors to allow timely decisions regarding required disclosure.

In connection with the preparation of this Quarterly Report on Form 10-Q, as of September 30, 2014, under the supervision and with the participation of our management, including our principal executive officer and principal financial officer, we conducted an evaluation of the effectiveness of our disclosure controls and procedures, as such term is defined under Rules 13a-15(e) and 15d-15(e) promulgated under the Exchange Act.

Based on this evaluation, our principal executive officer and principal financial officer concluded that our disclosure controls and procedures were effective at a reasonable assurance level as of September 30, 2014, the end of the period covered by this Quarterly Report.

Changes in Internal Controls

There have been no changes in our internal control over financial reporting (as defined in Exchange Act Rule 13a-15(f)) that have occurred during the quarter ended September 30, 2014, that have materially impacted, or are reasonably likely to materially impact, our internal control over financial reporting.

Inherent Limitations on Effectiveness of Controls

Our management, including our principal executive officer and principal financial officer, does not expect that our disclosure controls or our internal controls over financial reporting will prevent or detect all errors and all fraud. A control system, no matter how well designed and operated, can provide only reasonable, not absolute, assurance that the control system’s objectives will be met. The design of a control system must reflect the fact that there are resource constraints, and the benefits of controls must be considered relative to their costs. Further, because of the inherent limitations in all control systems, no evaluation of controls can provide absolute assurance that misstatements due to error or fraud will not occur or that all control issues and instances of fraud, if any, have been detected. These inherent limitations include the realities that judgments in decision-making can be faulty and that breakdowns can occur because of simple error or mistake. Controls can also be circumvented by the individual acts of some persons, by collusion of two or more people, or by management override of the controls. The design of any system of controls is based in part on certain assumptions about the likelihood of future events, and there can be no assurance that any design will succeed in achieving its stated goals under all potential future conditions. Projections of any evaluation of controls’ effectiveness to future periods are subject to risks. Over time, controls may become inadequate because of changes in conditions or deterioration in the degree of compliance with policies and procedures. Our disclosure controls and procedures are designed to provide reasonable assurance of achieving their objectives and, based on an evaluation of our controls and procedures, our principal executive officer and our principal financial officer concluded our disclosure controls and procedures were effective at a reasonable assurance level as of September 30, 2014, the end of the period covered by this Quarterly Report.

PART II. OTHER INFORMATION

ITEM 1. LEGAL PROCEEDINGS

See Note 6 to the condensed consolidated financial statements for information concerning our legal proceedings.

ITEM 1A. RISK FACTORS

In addition to the other information set forth in this Quarterly Report on Form 10-Q, you should carefully consider the risk factors included in Part I, “Item 1A. – “Risk Factors”” of our Annual Report on Form 10-K. These risk factors could materially impact our business, financial condition and/or operating results. Additional risks and uncertainties not currently known to us or that we currently deem to be immaterial also may materially adversely impact our business, financial condition and/or operating results.

 

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Table of Contents

ITEM 2. UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

The following table provides the information with respect to purchases made by us of shares of our common stock during each of the months during the three-month period ended September 30, 2014:

 

Period   (a) Total Number
of Share (or Units)
Purchased
    (b) Average Price
Paid per Share (or
Unit)
    (c) Total Number of
Shares (or Units)
Purchased as Part of
Publicly Announced
Plans or Programs
    (d) Maximum Number (or
Approximate Dollar
Value) of Shares (or
Units) That May Yet Be
Purchased Under the
Plans or Programs
 

July 1, 2014 to July 31, 2014

    109     $ 16.69       —       $ —    

August 1, 2014 to August 31, 2014

    —         —         —         —    

September 1, 2014 to September 30, 2014

    874       20.54       —         —    
 

 

 

   

 

 

   

 

 

   

 

 

 
    983  (1)    $ 20.11       —         —    
 

 

 

   

 

 

   

 

 

   

 

 

 

 

(1) Includes shares of common stock surrendered to us by certain employees to satisfy tax withholding obligations in connection with the vesting of non-vested stock previously awarded to such employees under our 2008 Omnibus Incentive Compensation Plan.

ITEM 3. DEFAULTS UPON SENIOR SECURITIES

None.

ITEM 4. MINE SAFETY DISCLOSURES

Not applicable.

ITEM 5. OTHER INFORMATION

On October 1, 2014, director Nathaniel M. Zilkha was appointed Chairman of the Compensation Committee of the Company’s Board of Directors.

ITEM 6. EXHIBITS

The exhibits marked with the cross symbol (†) are filed and the exhibits marked with a double cross (††) are furnished with this Form 10-Q. Any exhibits marked with the asterisk symbol (*) are management contracts or compensatory plans or arrangements filed pursuant to Item 601(b)(10)(iii) of Regulation S-K.

 

Exhibit

Number

  

Document Description

  

Report or Registration Statement

  

SEC File or
Registration
Number

  

Exhibit
or Other
Reference

      3.1    Composite of Certificate of Incorporation of the Company inclusive of all amendments through June 14, 2007    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2007    0-24260    3.1
      3.2    Composite of By-Laws of the Company inclusive of all amendments through February 24, 2014    The Company’s Annual Report on Form 10-K for the year ended December 31, 2013    0-24260    3.2
      4.1    Common Stock Specimen    The Company’s Registration Statement on Form S-3 filed August 20, 2007    333-145582    4.8
    10.1    Fourth Amendment dated as of July 28, 2014 to the Credit Agreement dated October 26, 2012 among Amedisys, Inc. and Amedisys Holding, L.L.C., as co-borrowers, the several banks and other financial institutions party thereto from time to time, BOKF, NA DBA Bank of Texas, Compass Bank, Fifth Third Bank and RBS Citizens, N.A., as Documentation Agents, Bank of America, N.A., as Syndication Agent, JPMorgan Chase Bank, N.A., as Administrative Agent, and J.P. Morgan Securities LLC and Merrill Lynch, Pierce, Fenner & Smith Incorporated, as Co-Lead Arrangers and Joint Bookrunners    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.1.2

 

32


Table of Contents

Exhibit

Number

  

Document Description

  

Report or Registration Statement

  

SEC File or
Registration
Number

  

Exhibit
or Other
Reference

    10.2    Second Lien Credit Agreement dated as of July 28, 2014 by and among Amedisys, Inc. and Amedisys Holding, L.L.C., as co-borrowers, the banks and other financial institutions or entities from time to time parties thereto as lenders, and Cortland Capital Market Services LLC, as Administrative Agent    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.8
    10.3    Second Lien Security and Pledge Agreement dated as of July 28, 2014 by and among Amedisys, Inc., Amedisys Holding, L.L.C, the guarantors party thereto and Cortland Capital Market Services LLC, not in its individual capacity, but solely as collateral agent for the secured parties    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.9
    10.4    Intercreditor Agreement dated as of July 28, 2014 by and among JPMorgan Chase Bank, N.A., as Administrative Agent for the first priority secured parties, Cortland Capital Market Services LLC, as Administrative Agent for the second priority secured parties, and the direct and indirect subsidiaries of Amedisys, Inc. and Amedisys Holding, L.L.C. from time to time party thereto    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.10
    10.5*    Amendment No. 3 dated May 1, 2014 to Employment Agreement dated November 1, 2011 by and among Amedisys, Inc., Amedisys Holding, L.L.C. and Ronald A. LaBorde    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.4
    10.6*    Amendment No. 3 dated May 1, 2014 to Employment Agreement dated November 1, 2011 by and among Amedisys, Inc., Amedisys Holding, L.L.C. and Michael O. Fleming    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.5
    10.7*    Amendment No. 2 dated May 1, 2014 to Employment Agreement dated November 1, 2011 by and among Amedisys, Inc., Amedisys Holding, L.L.C. and Jeffrey D. Jeter    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.6
    10.8*    Amendment No. 3 dated May 1, 2014 to Employment Agreement dated November 1, 2011 by and among Amedisys, Inc., Amedisys Holding, L.L.C. and David R. Bucey    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.7

 

33


Table of Contents

Exhibit

Number

  

Document Description

  

Report or Registration Statement

  

SEC File or
Registration
Number

  

Exhibit
or Other
Reference

  †31.1    Certification of Ronald A. LaBorde, Interim Chief Executive Officer (principal executive officer), pursuant to Section 302 of the Sarbanes-Oxley Act of 2002         
  †31.2    Certification of Dale E. Redman, Interim Chief Financial Officer (principal financial officer), pursuant to Section 302 of the Sarbanes-Oxley Act of 2002         
††32.1    Certification of Ronald A. LaBorde, Interim Chief Executive Officer (principal executive officer), pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002         
††32.2    Certification of Dale E. Redman, Interim Chief Financial Officer (principal financial officer), pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002         
†101.INS    XBRL Instance         
†101.SCH    XBRL Taxonomy Extension Schema Document         
†101.CAL    XBRL Taxonomy Extension Calculation Linkbase Document         
†101.DEF    XBRL Taxonomy Extension Definition Linkbase         
†101.LAB    XBRL Taxonomy Extension Labels Linkbase Document         
†101.PRE    XBRL Taxonomy Extension Presentation Linkbase Document         

 

34


Table of Contents

SIGNATURES

Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, as amended, the Registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.

 

AMEDISYS, INC.

(Registrant)

By:  

/s/ SCOTT G. GINN

  Scott G. Ginn,
 

Principal Accounting Officer and

Duly Authorized Officer

Date: October 29, 2014

 

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Table of Contents

EXHIBIT INDEX

The exhibits marked with the cross symbol (†) are filed and the exhibits marked with a double cross (††) are furnished with this Form 10-Q. Any exhibits marked with the asterisk symbol (*) are management contracts or compensatory plans or arrangements filed pursuant to Item 601(b)(10)(iii) of Regulation S-K.

 

Exhibit

Number

  

Document Description

  

Report or Registration Statement

  

SEC File or
Registration
Number

  

Exhibit
or Other
Reference

      3.1    Composite of Certificate of Incorporation of the Company inclusive of all amendments through June 14, 2007    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2007    0-24260    3.1
      3.2    Composite of By-Laws of the Company inclusive of all amendments through February 24, 2014    The Company’s Annual Report on Form 10-K for the year ended December 31, 2013    0-24260    3.2
      4.1    Common Stock Specimen    The Company’s Registration Statement on Form S-3 filed August 20, 2007    333-145582    4.8
    10.1    Fourth Amendment dated as of July 28, 2014 to the Credit Agreement dated October 26, 2012 among Amedisys, Inc. and Amedisys Holding, L.L.C., as co-borrowers, the several banks and other financial institutions party thereto from time to time, BOKF, NA DBA Bank of Texas, Compass Bank, Fifth Third Bank and RBS Citizens, N.A., as Documentation Agents, Bank of America, N.A., as Syndication Agent, JPMorgan Chase Bank, N.A., as Administrative Agent, and J.P. Morgan Securities LLC and Merrill Lynch, Pierce, Fenner & Smith Incorporated, as Co-Lead Arrangers and Joint Bookrunners    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.1.2
    10.2    Second Lien Credit Agreement dated as of July 28, 2014 by and among Amedisys, Inc. and Amedisys Holding, L.L.C., as co-borrowers, the banks and other financial institutions or entities from time to time parties thereto as lenders, and Cortland Capital Market Services LLC, as Administrative Agent    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.8
    10.3    Second Lien Security and Pledge Agreement dated as of July 28, 2014 by and among Amedisys, Inc., Amedisys Holding, L.L.C, the guarantors party thereto and Cortland Capital Market Services LLC, not in its individual capacity, but solely as collateral agent for the secured parties    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.9

 

36


Table of Contents

Exhibit

Number

  

Document Description

  

Report or Registration Statement

  

SEC File or
Registration
Number

  

Exhibit
or Other
Reference

    10.4    Intercreditor Agreement dated as of July 28, 2014 by and among JPMorgan Chase Bank, N.A., as Administrative Agent for the first priority secured parties, Cortland Capital Market Services LLC, as Administrative Agent for the second priority secured parties, and the direct and indirect subsidiaries of Amedisys, Inc. and Amedisys Holding, L.L.C. from time to time party thereto    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.10
    10.5*    Amendment No. 3 dated May 1, 2014 to Employment Agreement dated November 1, 2011 by and among Amedisys, Inc., Amedisys Holding, L.L.C. and Ronald A. LaBorde    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.4
    10.6*    Amendment No. 3 dated May 1, 2014 to Employment Agreement dated November 1, 2011 by and among Amedisys, Inc., Amedisys Holding, L.L.C. and Michael O. Fleming    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.5
    10.7*    Amendment No. 2 dated May 1, 2014 to Employment Agreement dated November 1, 2011 by and among Amedisys, Inc., Amedisys Holding, L.L.C. and Jeffrey D. Jeter    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.6
    10.8*    Amendment No. 3 dated May 1, 2014 to Employment Agreement dated November 1, 2011 by and among Amedisys, Inc., Amedisys Holding, L.L.C. and David R. Bucey    The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2014    0-24260    10.7
†31.1    Certification of Ronald A. LaBorde, Interim Chief Executive Officer (principal executive officer), pursuant to Section 302 of the Sarbanes-Oxley Act of 2002         
†31.2    Certification of Dale E. Redman, Interim Chief Financial Officer (principal financial officer), pursuant to Section 302 of the Sarbanes-Oxley Act of 2002         
††32.1    Certification of Ronald A. LaBorde, Interim Chief Executive Officer (principal executive officer), pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002         
††32.2    Certification of Dale E. Redman, Interim Chief Financial Officer (principal financial officer), pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002         
†101.INS    XBRL Instance         
†101.SCH    XBRL Taxonomy Extension Schema Document         
†101.CAL    XBRL Taxonomy Extension Calculation Linkbase Document         
†101.DEF    XBRL Taxonomy Extension Definition Linkbase         

 

37


Table of Contents

Exhibit

Number

  

Document Description

  

Report or Registration Statement

  

SEC File or
Registration
Number

  

Exhibit
or Other
Reference

†101.LAB    XBRL Taxonomy Extension Labels Linkbase Document         
†101.PRE    XBRL Taxonomy Extension Presentation Linkbase Document         

 

38

EX-31.1 2 d787955dex311.htm EX-31.1 EX-31.1

Exhibit 31.1

CERTIFICATION

I, Ronald A. LaBorde, certify that:

1. I have reviewed this Quarterly Report on Form 10-Q for the quarter ended September 30, 2014, of Amedisys, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a. Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b. Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c. Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d. Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an Annual Report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of registrant’s Board of Directors (or persons performing the equivalent functions):

a. All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b. Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: October 29, 2014

 

/S/ Ronald A. LaBorde

Ronald A. LaBorde
Principal Executive Officer
EX-31.2 3 d787955dex312.htm EX-31.2 EX-31.2

Exhibit 31.2

CERTIFICATION

I, Dale E. Redman, certify that:

1. I have reviewed this Quarterly Report on Form 10-Q for the quarter ended September 30, 2014, of Amedisys, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a. Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b. Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c. Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d. Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an Annual Report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of registrant’s Board of Directors (or persons performing the equivalent functions):

a. All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b. Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: October 29, 2014

 

/S/ Dale E. Redman

Dale E. Redman
Principal Financial Officer
EX-32.1 4 d787955dex321.htm EX-32.1 EX-32.1

Exhibit 32.1

CERTIFICATION OF CHIEF EXECUTIVE OFFICER PURSUANT TO 18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of Amedisys, Inc. (the “Company”) on Form 10-Q for the quarter ended September 30, 2014 (the “Report”), I, Ronald A. LaBorde, Principal Executive Officer of the Company, hereby certify to my knowledge, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that:

(1) The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(2) The information contained in the Report fairly presents, in all material respects, the financial condition and result of operations of the Company.

Date: October 29, 2014

 

/S/ Ronald A. LaBorde

Ronald A. LaBorde
Principal Executive Officer
EX-32.2 5 d787955dex322.htm EX-32.2 EX-32.2

Exhibit 32.2

CERTIFICATION OF CHIEF EXECUTIVE OFFICER PURSUANT TO 18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of Amedisys, Inc. (the “Company”) on Form 10-Q for the quarter ended September 30, 2014 (the “Report”), I, Dale E. Redman, Principal Financial Officer of the Company, hereby certify to my knowledge, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that:

(1) The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(2) The information contained in the Report fairly presents, in all material respects, the financial condition and result of operations of the Company.

Date: October 29, 2014

 

/S/ Dale E. Redman

Dale E. Redman
Principal Financial Officer
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All significant intercompany accounts and transactions have been eliminated in our accompanying </font><font style="font-family:Times New Roman;font-size:10pt;">unaudited condensed </font><font style="font-family:Times New Roman;font-size:10pt;">consolidated financial statements, and business combinations accounted for as purchases have been included in our</font><font style="font-family:Times New Roman;font-size:10pt;"> unaudited condensed</font><font style="font-family:Times New Roman;font-size:10pt;"> consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">investments that are </font><font style="font-family:Times New Roman;font-size:10pt;">accounted for as set forth below</font><font style="font-family:Times New Roman;font-size:10pt;">.</font></p> 0.5 0.2 0.5 <p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Use of Estimates </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Our accounting and reporting policies conform with U.S.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">G</font><font style="font-family:Times New Roman;font-size:10pt;">AAP. In preparing the </font><font style="font-family:Times New Roman;font-size:10pt;">unaudited condensed </font><font style="font-family:Times New Roman;font-size:10pt;">consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the</font><font style="font-family:Times New Roman;font-size:10pt;"> condensed</font><font style="font-family:Times New Roman;font-size:10pt;"> consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates. </font></p> <p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Reclassifications </font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;">and Comparability </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Certain reclassifications have been made to prior period's financial statements in order to conform to the current period's presentation</font><font style="font-family:Times New Roman;font-size:10pt;">.</font></p><p style='margin-top:6pt; margin-bottom:0pt'>&#160;</p> 34 <p style='margin-top:0pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;margin-left:0px;">1</font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;">. NATURE OF OPERATIONS</font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;">,</font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;"> </font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;">CONSOLIDATION </font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;">AND PRESENTATION </font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;">OF FINANCIAL STATEMENTS </font></p><p style='margin-top:9pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Amedisys, Inc., a Delaware corporation, and its consolidated subsidiaries (&#8220;Amedisys,&#8221; &#8220;we,&#8221; &#8220;us,&#8221; or &#8220;our&#8221;) </font><font style="font-family:Times New Roman;font-size:10pt;">are</font><font style="font-family:Times New Roman;font-size:10pt;"> a multi-state provider of home health and hospice services with </font><font style="font-family:Times New Roman;font-size:10pt;">approximately</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">81%</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">and </font><font style="font-family:Times New Roman;font-size:10pt;">84%</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">of our revenue derived from Medicare for the three</font><font style="font-family:Times New Roman;font-size:10pt;">-</font><font style="font-family:Times New Roman;font-size:10pt;">month</font><font style="font-family:Times New Roman;font-size:10pt;"> periods</font><font style="font-family:Times New Roman;font-size:10pt;"> ended </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">, respectively</font><font style="font-family:Times New Roman;font-size:10pt;">, and approximately </font><font style="font-family:Times New Roman;font-size:10pt;">82%</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">84%</font><font style="font-family:Times New Roman;font-size:10pt;"> our revenue</font><font style="font-family:Times New Roman;font-size:10pt;"> derived from Medicare for the nine</font><font style="font-family:Times New Roman;font-size:10pt;">-month periods ended </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">, respectively</font><font style="font-family:Times New Roman;font-size:10pt;">. </font><font style="font-family:Times New Roman;font-size:10pt;">As of </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;">, we owned and operated </font><font style="font-family:Times New Roman;font-size:10pt;">316</font><font style="font-family:Times New Roman;font-size:10pt;"> Medicare-certified home health </font><font style="font-family:Times New Roman;font-size:10pt;">care centers</font><font style="font-family:Times New Roman;font-size:10pt;"> and</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">80</font><font style="font-family:Times New Roman;font-size:10pt;"> Medicare-certified hospice </font><font style="font-family:Times New Roman;font-size:10pt;">care centers </font><font style="font-family:Times New Roman;font-size:10pt;">in </font><font style="font-family:Times New Roman;font-size:10pt;">34</font><font style="font-family:Times New Roman;font-size:10pt;"> states within the United States, the District of Columbia and Puerto Rico</font><font style="font-family:Times New Roman;font-size:10pt;">.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Basis of Presentation</font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting solely of normal recurring adjustments) necessary to present fairly our financial position, our results of operations and our cash flows in accordance with U.S. Generally Accepted Accounting Principles (&#8220;U.S. GAAP&#8221;). 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This report should be read in conjunction with our consolidated financial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 201</font><font style="font-family:Times New Roman;font-size:10pt;">3</font><font style="font-family:Times New Roman;font-size:10pt;"> as filed with the Securities and Exchange Commission (&#8220;SEC&#8221;) on </font><font style="font-family:Times New Roman;font-size:10pt;">March 12</font><font style="font-family:Times New Roman;font-size:10pt;">, 201</font><font style="font-family:Times New Roman;font-size:10pt;">4</font><font style="font-family:Times New Roman;font-size:10pt;"> (the &#8220;Form 10-K&#8221;), which includes information and disclosures not included herein</font><font style="font-family:Times New Roman;font-size:10pt;">.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Use of Estimates </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Our accounting and reporting policies conform with U.S.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">G</font><font style="font-family:Times New Roman;font-size:10pt;">AAP. In preparing the </font><font style="font-family:Times New Roman;font-size:10pt;">unaudited condensed </font><font style="font-family:Times New Roman;font-size:10pt;">consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the</font><font style="font-family:Times New Roman;font-size:10pt;"> condensed</font><font style="font-family:Times New Roman;font-size:10pt;"> consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Reclassifications </font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;">and Comparability </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Certain reclassifications have been made to prior period's financial statements in order to conform to the current period's presentation</font><font style="font-family:Times New Roman;font-size:10pt;">.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Principles of Consolidation </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">These </font><font style="font-family:Times New Roman;font-size:10pt;">unaudited condensed </font><font style="font-family:Times New Roman;font-size:10pt;">consolidated financial statements include the accounts of Amedisys, Inc.</font><font style="font-family:Times New Roman;font-size:10pt;">,</font><font style="font-family:Times New Roman;font-size:10pt;"> and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying </font><font style="font-family:Times New Roman;font-size:10pt;">unaudited condensed </font><font style="font-family:Times New Roman;font-size:10pt;">consolidated financial statements, and business combinations accounted for as purchases have been included in our</font><font style="font-family:Times New Roman;font-size:10pt;"> unaudited condensed</font><font style="font-family:Times New Roman;font-size:10pt;"> consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">investments that are </font><font style="font-family:Times New Roman;font-size:10pt;">accounted for as set forth below</font><font style="font-family:Times New Roman;font-size:10pt;">.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Investments </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We consolidate </font><font style="font-family:Times New Roman;font-size:10pt;">investments when the entity is a variable interest </font><font style="font-family:Times New Roman;font-size:10pt;">entity and </font><font style="font-family:Times New Roman;font-size:10pt;">we </font><font style="font-family:Times New Roman;font-size:10pt;">are</font><font style="font-family:Times New Roman;font-size:10pt;"> the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of </font><font style="font-family:Times New Roman;font-size:10pt;">50</font><font style="font-family:Times New Roman;font-size:10pt;">%. </font><font style="font-family:Times New Roman;font-size:10pt;">Third party equity interests in our consolidated joint ventures are reflected as </font><font style="font-family:Times New Roman;font-size:10pt;">noncontrolling</font><font style="font-family:Times New Roman;font-size:10pt;"> interests in our </font><font style="font-family:Times New Roman;font-size:10pt;">condensed </font><font style="font-family:Times New Roman;font-size:10pt;">consolidated financial statements.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We account for investments in entities in which we have the ability to exercise significant influence under the equity method if we hold </font><font style="font-family:Times New Roman;font-size:10pt;">50</font><font style="font-family:Times New Roman;font-size:10pt;">% or less of the voting stock and the entity is not a variable interest entity in which we are the primary </font><font style="font-family:Times New Roman;font-size:10pt;">beneficiary. The book value of </font><font style="font-family:Times New Roman;font-size:10pt;">investments </font><font style="font-family:Times New Roman;font-size:10pt;">that we </font><font style="font-family:Times New Roman;font-size:10pt;">accounted for under the equity method of accounting was $</font><font style="font-family:Times New Roman;font-size:10pt;">15.5</font><font style="font-family:Times New Roman;font-size:10pt;"> million as of </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30</font><font style="font-family:Times New Roman;font-size:10pt;">, 201</font><font style="font-family:Times New Roman;font-size:10pt;">4</font><font style="font-family:Times New Roman;font-size:10pt;">,</font><font style="font-family:Times New Roman;font-size:10pt;"> and $</font><font style="font-family:Times New Roman;font-size:10pt;">11.9</font><font style="font-family:Times New Roman;font-size:10pt;"> million as of De</font><font style="font-family:Times New Roman;font-size:10pt;">cember 31, 2013</font><font style="font-family:Times New Roman;font-size:10pt;">. We account for investments in entities in which we have less than a </font><font style="font-family:Times New Roman;font-size:10pt;">20</font><font style="font-family:Times New Roman;font-size:10pt;">% ownership interest under the cost method of accounting if we do not </font><font style="font-family:Times New Roman;font-size:10pt;">have the ability to exercise significant influence over the investee. The aggregate carrying amount of our cost method investment</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">was </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">5</font><font style="font-family:Times New Roman;font-size:10pt;">.0 </font><font style="font-family:Times New Roman;font-size:10pt;">million</font><font style="font-family:Times New Roman;font-size:10pt;"> as of </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30</font><font style="font-family:Times New Roman;font-size:10pt;">, 2014 and </font><font style="font-family:Times New Roman;font-size:10pt;">December 31, 2013.</font></p> <p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Investments </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We consolidate </font><font style="font-family:Times New Roman;font-size:10pt;">investments when the entity is a variable interest </font><font style="font-family:Times New Roman;font-size:10pt;">entity and </font><font style="font-family:Times New Roman;font-size:10pt;">we </font><font style="font-family:Times New Roman;font-size:10pt;">are</font><font style="font-family:Times New Roman;font-size:10pt;"> the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of </font><font style="font-family:Times New Roman;font-size:10pt;">50</font><font style="font-family:Times New Roman;font-size:10pt;">%. </font><font style="font-family:Times New Roman;font-size:10pt;">Third party equity interests in our consolidated joint ventures are reflected as </font><font style="font-family:Times New Roman;font-size:10pt;">noncontrolling</font><font style="font-family:Times New Roman;font-size:10pt;"> interests in our </font><font style="font-family:Times New Roman;font-size:10pt;">condensed </font><font style="font-family:Times New Roman;font-size:10pt;">consolidated financial statements.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We account for investments in entities in which we have the ability to exercise significant influence under the equity method if we hold </font><font style="font-family:Times New Roman;font-size:10pt;">50</font><font style="font-family:Times New Roman;font-size:10pt;">% or less of the voting stock and the entity is not a variable interest entity in which we are the primary </font><font style="font-family:Times New Roman;font-size:10pt;">beneficiary. The book value of </font><font style="font-family:Times New Roman;font-size:10pt;">investments </font><font style="font-family:Times New Roman;font-size:10pt;">that we </font><font style="font-family:Times New Roman;font-size:10pt;">accounted for under the equity method of accounting was $</font><font style="font-family:Times New Roman;font-size:10pt;">15.5</font><font style="font-family:Times New Roman;font-size:10pt;"> million as of </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30</font><font style="font-family:Times New Roman;font-size:10pt;">, 201</font><font style="font-family:Times New Roman;font-size:10pt;">4</font><font style="font-family:Times New Roman;font-size:10pt;">,</font><font style="font-family:Times New Roman;font-size:10pt;"> and $</font><font style="font-family:Times New Roman;font-size:10pt;">11.9</font><font style="font-family:Times New Roman;font-size:10pt;"> million as of De</font><font style="font-family:Times New Roman;font-size:10pt;">cember 31, 2013</font><font style="font-family:Times New Roman;font-size:10pt;">. We account for investments in entities in which we have less than a </font><font style="font-family:Times New Roman;font-size:10pt;">20</font><font style="font-family:Times New Roman;font-size:10pt;">% ownership interest under the cost method of accounting if we do not </font><font style="font-family:Times New Roman;font-size:10pt;">have the ability to exercise significant influence over the investee. The aggregate carrying amount of our cost method investment</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">was </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">5</font><font style="font-family:Times New Roman;font-size:10pt;">.0 </font><font style="font-family:Times New Roman;font-size:10pt;">million</font><font style="font-family:Times New Roman;font-size:10pt;"> as of </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30</font><font style="font-family:Times New Roman;font-size:10pt;">, 2014 and </font><font style="font-family:Times New Roman;font-size:10pt;">December 31, 2013.</font></p> 316 80 0.81 0.84 5000000 11900000 15500000 5000000 0.82 0.84 0.1 <p style='margin-top:0pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;margin-left:0px;">2</font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;">. </font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;">Summary of Significant Accounting Policies</font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;"> </font></p><p style='margin-top:9pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Revenue Recognition</font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;"> </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We earn net service revenue through our home health and hospice </font><font style="font-family:Times New Roman;font-size:10pt;">care center</font><font style="font-family:Times New Roman;font-size:10pt;">s by providing a variety of services almost exclusively in the homes of our patients. This net service revenue is earned and billed either on an episode of care basis, on a per visit basis or on a daily basis depending upon the payment terms and conditions established with each </font><font style="font-family:Times New Roman;font-size:10pt;">payor</font><font style="font-family:Times New Roman;font-size:10pt;"> for services provided. We refer to home health revenue earned and billed on a </font><font style="font-family:Times New Roman;font-size:10pt;">60</font><font style="font-family:Times New Roman;font-size:10pt;">-day episode of care as episodic-based revenue. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">When we record our service revenue, we record it net of estimated revenue adjustments and contractual adjustments to reflect amounts we estimate to be realizable for services provided, as discussed below. We believe, based on information currently available to us and based on our judgment, that changes to one or more factors that impact the accounting estimates (such as our estimates related to revenue adjustments, contractual adjustments and episodes in progress) we make in determining net service revenue, which changes are likely to occur from period to period, will not materially impact our reported consolidated financial condition, results of operations, cash flows or our future financial results. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Home Health Revenue Recognition</font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;text-decoration:underline;margin-left:0px;">Medicare Revenue </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Net service revenue is recorded under the Medicare prospective payment system (&#8220;PPS&#8221;) based on a </font><font style="font-family:Times New Roman;font-size:10pt;">60</font><font style="font-family:Times New Roman;font-size:10pt;">-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a)&#160;an outlier payment if our patient's care was unusually costly (capped at </font><font style="font-family:Times New Roman;font-size:10pt;">10</font><font style="font-family:Times New Roman;font-size:10pt;">% of total reimbursement per provider number); (b)&#160;a low utilization payment adjustment (&#8220;LUPA&#8221;) if the number of visits was fewer than five; (c)&#160;a partial payment if our patient transferred to another provider or we received a patient from another provider before completing the episode; (d)&#160;a payment adjustment based upon the level of therapy services required (</font><font style="font-family:Times New Roman;font-size:10pt;">with various incremental adjustments made for additional visits, with larger payment increases associated with the sixth, fourteenth and twentieth visit thresholds</font><font style="font-family:Times New Roman;font-size:10pt;">); </font><font style="font-family:Times New Roman;font-size:10pt;">(</font><font style="font-family:Times New Roman;font-size:10pt;">e</font><font style="font-family:Times New Roman;font-size:10pt;">) adjustments to payments if we are unable to perform periodic therapy assessments; </font><font style="font-family:Times New Roman;font-size:10pt;">(</font><font style="font-family:Times New Roman;font-size:10pt;">f</font><font style="font-family:Times New Roman;font-size:10pt;">)&#160;the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (</font><font style="font-family:Times New Roman;font-size:10pt;">g</font><font style="font-family:Times New Roman;font-size:10pt;">)&#160;changes in the base episode payments established by the Medicare Program; (</font><font style="font-family:Times New Roman;font-size:10pt;">h</font><font style="font-family:Times New Roman;font-size:10pt;">)&#160;adjustments to the base episode payments for case mix and geographic wages; and (</font><font style="font-family:Times New Roman;font-size:10pt;">i</font><font style="font-family:Times New Roman;font-size:10pt;">)&#160;recoveries of overpayments. </font><font style="font-family:Times New Roman;font-size:10pt;">In addition, we make adjustments to Medicare revenue if we </font><font style="font-family:Times New Roman;font-size:10pt;">find that we </font><font style="font-family:Times New Roman;font-size:10pt;">are unable to produce </font><font style="font-family:Times New Roman;font-size:10pt;">appropriate </font><font style="font-family:Times New Roman;font-size:10pt;">documentation </font><font style="font-family:Times New Roman;font-size:10pt;">of a face to face encounter between the patient and physician</font><font style="font-family:Times New Roman;font-size:10pt;">.</font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We make adjustments to Medicare revenue to reflect</font><font style="font-family:Times New Roman;font-size:10pt;"> differences between estimated and actual payment amounts, </font><font style="font-family:Times New Roman;font-size:10pt;">our discovered </font><font style="font-family:Times New Roman;font-size:10pt;">inability to obtain appropriate billing documentation </font><font style="font-family:Times New Roman;font-size:10pt;">or </font><font style="font-family:Times New Roman;font-size:10pt;">authorizations and other reasons unrelated to credit risk. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of </font><font style="font-family:Times New Roman;font-size:10pt;">over </font><font style="font-family:Times New Roman;font-size:10pt;">99</font><font style="font-family:Times New Roman;font-size:10pt;">%</font><font style="font-family:Times New Roman;font-size:10pt;"> on</font><font style="font-family:Times New Roman;font-size:10pt;"> Medicare claims, and record this estimate during the period in which services are rendered as an estimated revenue adjustment and a corresponding reduction to patient accounts receivable.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">Therefore, we believe that our reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In addition to revenue recognized on completed episodes, we also recognize a portion of revenue associated with episodes in progress. Episodes in progress are </font><font style="font-family:Times New Roman;font-size:10pt;">60</font><font style="font-family:Times New Roman;font-size:10pt;">-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. We estimate this revenue on a monthly basis based upon historical trends. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and our estimate of the average percentage complete based on visits performed. As of </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">, the difference between the cash received from Medicare for a request for anticipated payment (&#8220;RAP&#8221;) on episodes in progress and the associated estimated revenue was immaterial and, therefore, the resulting credits were recorded as a reduction to our outstanding pa</font><font style="font-family:Times New Roman;font-size:10pt;">tient accounts receivable in our condensed </font><font style="font-family:Times New Roman;font-size:10pt;">consolidated balance sheets for such periods. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;text-decoration:underline;margin-left:0px;">Non-Medicare Revenue </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Episodic-based Revenue. </font><font style="font-family:Times New Roman;font-size:10pt;">We recognize revenue in a similar manner as we recognize Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Non-episodic </font><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;">b</font><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;">ased Revenue. </font><font style="font-family:Times New Roman;font-size:10pt;">Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates, as applicable. Contractual adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue and are also recorded as a reduction to our outstanding patient accounts receivable. In addition, we receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Hospice Revenue Recognition </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;text-decoration:underline;margin-left:0px;">Hospice Medicare Revenue </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily or hourly rates for each of the four levels of care we deliver. The four levels of care</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">are routine care, general inpatient care, continuous home care and respite care. Routine care accounts </font><font style="font-family:Times New Roman;font-size:10pt;">for </font><font style="font-family:Times New Roman;font-size:10pt;">9</font><font style="font-family:Times New Roman;font-size:10pt;">6</font><font style="font-family:Times New Roman;font-size:10pt;">%</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">and </font><font style="font-family:Times New Roman;font-size:10pt;">100</font><font style="font-family:Times New Roman;font-size:10pt;">% </font><font style="font-family:Times New Roman;font-size:10pt;">of our total</font><font style="font-family:Times New Roman;font-size:10pt;"> Medicare hospice service revenue for the</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">three</font><font style="font-family:Times New Roman;font-size:10pt;">-month periods ended </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">and </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">, respectively</font><font style="font-family:Times New Roman;font-size:10pt;">,</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">9</font><font style="font-family:Times New Roman;font-size:10pt;">8</font><font style="font-family:Times New Roman;font-size:10pt;">% </font><font style="font-family:Times New Roman;font-size:10pt;">and 99% </font><font style="font-family:Times New Roman;font-size:10pt;">of our total</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">Medicare hospice service revenue for the </font><font style="font-family:Times New Roman;font-size:10pt;">nine</font><font style="font-family:Times New Roman;font-size:10pt;">-</font><font style="font-family:Times New Roman;font-size:10pt;">mon</font><font style="font-family:Times New Roman;font-size:10pt;">th</font><font style="font-family:Times New Roman;font-size:10pt;"> periods</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">ended </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">, respectively</font><font style="font-family:Times New Roman;font-size:10pt;">. </font><font style="font-family:Times New Roman;font-size:10pt;">We make adjustments to Medicare revenue for an inability to obtain appropriate billing documentation</font><font style="font-family:Times New Roman;font-size:10pt;"> or </font><font style="font-family:Times New Roman;font-size:10pt;">acceptable </font><font style="font-family:Times New Roman;font-size:10pt;">authorizations</font><font style="font-family:Times New Roman;font-size:10pt;"> and</font><font style="font-family:Times New Roman;font-size:10pt;"> other reasons unrelated to credit risk. We estimate the impact of these adjustments based on our historical experience, which primarily includes our historical collection rate on Medicare claims, and record it during the period services are rendered as an estimated revenue adjustment and as a reduction to our outstanding patient accounts receivable. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap for each provider number, we monitor these caps and estimate amounts due back to Medicare if a cap has been exceeded.&#160;We record these adjustments as a reduction to revenue and an increase in other accrued liabilities.&#160; We have settled our Medicare hospice reimbursements for all fiscal y</font><font style="font-family:Times New Roman;font-size:10pt;">ears through October 31, 20</font><font style="font-family:Times New Roman;font-size:10pt;">12 as of </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;">. </font><font style="font-family:Times New Roman;font-size:10pt;">As of </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30, 2014, we have recorded $</font><font style="font-family:Times New Roman;font-size:10pt;">2</font><font style="font-family:Times New Roman;font-size:10pt;">.</font><font style="font-family:Times New Roman;font-size:10pt;">8</font><font style="font-family:Times New Roman;font-size:10pt;"> million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2013 through October 31, 2014.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">As of December 31, 2013, we have recorded $4.0 million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2012 through October 31, 2014.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;text-decoration:underline;margin-left:0px;">Hospice Non-Medicare Revenue </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We record gross revenue on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per </font><font style="font-family:Times New Roman;font-size:10pt;">day </font><font style="font-family:Times New Roman;font-size:10pt;">rates, as applicable. Contractual adjustments are recorded for the difference between our established rates and the amounts estimated to be realizable from patients, third parties and others for services provided and are deducted from gross revenue to determine our net service revenue and patient accounts receiva</font><font style="font-family:Times New Roman;font-size:10pt;">ble.</font></p><p style='margin-top: 0pt; margin-bottom: 0pt;'></p><p style='margin-top:12pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Patient Accounts Receivable </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party </font><font style="font-family:Times New Roman;font-size:10pt;">payors</font><font style="font-family:Times New Roman;font-size:10pt;"> and patients. </font><font style="font-family:Times New Roman;font-size:10pt;">There is no single </font><font style="font-family:Times New Roman;font-size:10pt;">payor</font><font style="font-family:Times New Roman;font-size:10pt;">, other than </font><font style="font-family:Times New Roman;font-size:10pt;">Medicare, that accounts for more than </font><font style="font-family:Times New Roman;font-size:10pt;">10</font><font style="font-family:Times New Roman;font-size:10pt;">% of our total</font><font style="font-family:Times New Roman;font-size:10pt;"> outstanding patient receivables,</font><font style="font-family:Times New Roman;font-size:10pt;"> and thus we believe there are no other significant concentrations of receivables that would subject us to any significant credit risk in the collection of our patient accounts receivable. We fully reserve for accounts which are aged at </font><font style="font-family:Times New Roman;font-size:10pt;">36</font><font style="font-family:Times New Roman;font-size:10pt;">5</font><font style="font-family:Times New Roman;font-size:10pt;"> days or greater. We write off accounts on a monthly basis once we have exhausted our collection efforts and deem an account to be uncollectible. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We believe the credit risk associated with our Medicare </font><font style="font-family:Times New Roman;font-size:10pt;">accounts, which represent</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">6</font><font style="font-family:Times New Roman;font-size:10pt;">7</font><font style="font-family:Times New Roman;font-size:10pt;">% </font><font style="font-family:Times New Roman;font-size:10pt;">of our</font><font style="font-family:Times New Roman;font-size:10pt;"> net patient accounts receivable at </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">December 31, </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">, </font><font style="font-family:Times New Roman;font-size:10pt;">is limited due to our historical collection rate of over </font><font style="font-family:Times New Roman;font-size:10pt;">99</font><font style="font-family:Times New Roman;font-size:10pt;">% </font><font style="font-family:Times New Roman;font-size:10pt;">from Medicare and the fact that Medicare is a U.S. government </font><font style="font-family:Times New Roman;font-size:10pt;">payor</font><font style="font-family:Times New Roman;font-size:10pt;">. Accordingly, we do not record an allowance for doubtful accounts for our Medicare patient accounts receivable, which are recorded at their net realizable value after recording estimated revenue </font><font style="font-family:Times New Roman;font-size:10pt;">adjustments as discussed above. </font><font style="font-family:Times New Roman;font-size:10pt;">During the three </font><font style="font-family:Times New Roman;font-size:10pt;">and </font><font style="font-family:Times New Roman;font-size:10pt;">nine</font><font style="font-family:Times New Roman;font-size:10pt;">-</font><font style="font-family:Times New Roman;font-size:10pt;">month</font><font style="font-family:Times New Roman;font-size:10pt;"> periods</font><font style="font-family:Times New Roman;font-size:10pt;"> ended </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30</font><font style="font-family:Times New Roman;font-size:10pt;">, </font><font style="font-family:Times New Roman;font-size:10pt;">2014</font><font style="font-family:Times New Roman;font-size:10pt;">, we recorded </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">1.4</font><font style="font-family:Times New Roman;font-size:10pt;"> million and </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">4.</font><font style="font-family:Times New Roman;font-size:10pt;">1</font><font style="font-family:Times New Roman;font-size:10pt;"> million, respectively, in estimated revenue adjustments to Medicare as compared to </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">2.5</font><font style="font-family:Times New Roman;font-size:10pt;"> million and </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">9.1</font><font style="font-family:Times New Roman;font-size:10pt;"> million during the three and </font><font style="font-family:Times New Roman;font-size:10pt;">nine</font><font style="font-family:Times New Roman;font-size:10pt;">-month periods ended </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30, </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">,</font><font style="font-family:Times New Roman;font-size:10pt;"> respectively.</font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We believe there is a certain level of credit risk associated with non-Medicare </font><font style="font-family:Times New Roman;font-size:10pt;">payors</font><font style="font-family:Times New Roman;font-size:10pt;">. To provide for our non-Medicare patient accounts receivable that could become uncollectible in the future, we establish an allowance for doubtful accounts to reduce the carrying amount to its estimated net realizable value.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Medicare Home Health </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for </font><font style="font-family:Times New Roman;font-size:10pt;">60</font><font style="font-family:Times New Roman;font-size:10pt;">% of our estimated payment for the initial episode at the start of care or </font><font style="font-family:Times New Roman;font-size:10pt;">50</font><font style="font-family:Times New Roman;font-size:10pt;">% of the estimated payment for any subsequent episodes of care contiguous with the first episode for a particular patient. The full amount of the episode is billed after the episode has been completed (&#8220;final billed&#8221;). The RAP received for that particular episode is then deducted from our final payment. If a final bill is not submitted within the greater of </font><font style="font-family:Times New Roman;font-size:10pt;">120</font><font style="font-family:Times New Roman;font-size:10pt;"> days from the start of the episode, or </font><font style="font-family:Times New Roman;font-size:10pt;">60</font><font style="font-family:Times New Roman;font-size:10pt;"> days from the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare from any other claims in process for that particular provider number. The RAP and final claim must then be re-submitted. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Medicare Hospice </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services t</font><font style="font-family:Times New Roman;font-size:10pt;">hat we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. </font><font style="font-family:Times New Roman;font-size:10pt;">Once each patient has been confirmed for eligibility, we will bill Medicare on a monthly basis for the services provided to the patient. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Non-Medicare Home Health and Hospice </font></p><p style='margin-top:4.5pt; margin-bottom:6pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient's eligibility for services with the applicable </font><font style="font-family:Times New Roman;font-size:10pt;">payor</font><font style="font-family:Times New Roman;font-size:10pt;">. Once the patient has been confirmed for eligibility, we will provide services to the patient </font><font style="font-family:Times New Roman;font-size:10pt;">and bill the applicable </font><font style="font-family:Times New Roman;font-size:10pt;">payor</font><font style="font-family:Times New Roman;font-size:10pt;">. </font><font style="font-family:Times New Roman;font-size:10pt;">Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular </font><font style="font-family:Times New Roman;font-size:10pt;">payors</font><font style="font-family:Times New Roman;font-size:10pt;"> or groups of </font><font style="font-family:Times New Roman;font-size:10pt;">payors</font><font style="font-family:Times New Roman;font-size:10pt;"> with similar characteristics that would subject us to any significant credit risk. </font><font style="font-family:Times New Roman;font-size:10pt;">We estimate an allowance for doubtful accounts</font><font style="font-family:Times New Roman;font-size:10pt;"> based upon our assessment of historical and expected net collections, business and economic conditions, trends in payment and an evaluation of </font><font style="font-family:Times New Roman;font-size:10pt;">collectibility</font><font style="font-family:Times New Roman;font-size:10pt;"> based upon the date that the service was provided. 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The ASU will replace most existing revenue recognition guidance in U.S. GAAP when it becomes effective</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">on January 1, 2017. Early application is not permitted. The standard permits the use of either the retrospective or cumulative effect transition method. The Company is evaluating the effect that ASU 2014-09 will have on its consolidated financial statements and related disclosures. The Company has not yet selected a transition method nor has it determined the effect of the standard on its ongoing financial reporting</font><font style="font-family:Times New Roman;font-size:10pt;">.</font></p> <p style='margin-top:9pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Revenue Recognition</font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;"> </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We earn net service revenue through our home health and hospice </font><font style="font-family:Times New Roman;font-size:10pt;">care center</font><font style="font-family:Times New Roman;font-size:10pt;">s by providing a variety of services almost exclusively in the homes of our patients. This net service revenue is earned and billed either on an episode of care basis, on a per visit basis or on a daily basis depending upon the payment terms and conditions established with each </font><font style="font-family:Times New Roman;font-size:10pt;">payor</font><font style="font-family:Times New Roman;font-size:10pt;"> for services provided. We refer to home health revenue earned and billed on a </font><font style="font-family:Times New Roman;font-size:10pt;">60</font><font style="font-family:Times New Roman;font-size:10pt;">-day episode of care as episodic-based revenue. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">When we record our service revenue, we record it net of estimated revenue adjustments and contractual adjustments to reflect amounts we estimate to be realizable for services provided, as discussed below. We believe, based on information currently available to us and based on our judgment, that changes to one or more factors that impact the accounting estimates (such as our estimates related to revenue adjustments, contractual adjustments and episodes in progress) we make in determining net service revenue, which changes are likely to occur from period to period, will not materially impact our reported consolidated financial condition, results of operations, cash flows or our future financial results. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Home Health Revenue Recognition</font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;text-decoration:underline;margin-left:0px;">Medicare Revenue </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Net service revenue is recorded under the Medicare prospective payment system (&#8220;PPS&#8221;) based on a </font><font style="font-family:Times New Roman;font-size:10pt;">60</font><font style="font-family:Times New Roman;font-size:10pt;">-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a)&#160;an outlier payment if our patient's care was unusually costly (capped at </font><font style="font-family:Times New Roman;font-size:10pt;">10</font><font style="font-family:Times New Roman;font-size:10pt;">% of total reimbursement per provider number); (b)&#160;a low utilization payment adjustment (&#8220;LUPA&#8221;) if the number of visits was fewer than five; (c)&#160;a partial payment if our patient transferred to another provider or we received a patient from another provider before completing the episode; (d)&#160;a payment adjustment based upon the level of therapy services required (</font><font style="font-family:Times New Roman;font-size:10pt;">with various incremental adjustments made for additional visits, with larger payment increases associated with the sixth, fourteenth and twentieth visit thresholds</font><font style="font-family:Times New Roman;font-size:10pt;">); </font><font style="font-family:Times New Roman;font-size:10pt;">(</font><font style="font-family:Times New Roman;font-size:10pt;">e</font><font style="font-family:Times New Roman;font-size:10pt;">) adjustments to payments if we are unable to perform periodic therapy assessments; </font><font style="font-family:Times New Roman;font-size:10pt;">(</font><font style="font-family:Times New Roman;font-size:10pt;">f</font><font style="font-family:Times New Roman;font-size:10pt;">)&#160;the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (</font><font style="font-family:Times New Roman;font-size:10pt;">g</font><font style="font-family:Times New Roman;font-size:10pt;">)&#160;changes in the base episode payments established by the Medicare Program; (</font><font style="font-family:Times New Roman;font-size:10pt;">h</font><font style="font-family:Times New Roman;font-size:10pt;">)&#160;adjustments to the base episode payments for case mix and geographic wages; and (</font><font style="font-family:Times New Roman;font-size:10pt;">i</font><font style="font-family:Times New Roman;font-size:10pt;">)&#160;recoveries of overpayments. </font><font style="font-family:Times New Roman;font-size:10pt;">In addition, we make adjustments to Medicare revenue if we </font><font style="font-family:Times New Roman;font-size:10pt;">find that we </font><font style="font-family:Times New Roman;font-size:10pt;">are unable to produce </font><font style="font-family:Times New Roman;font-size:10pt;">appropriate </font><font style="font-family:Times New Roman;font-size:10pt;">documentation </font><font style="font-family:Times New Roman;font-size:10pt;">of a face to face encounter between the patient and physician</font><font style="font-family:Times New Roman;font-size:10pt;">.</font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We make adjustments to Medicare revenue to reflect</font><font style="font-family:Times New Roman;font-size:10pt;"> differences between estimated and actual payment amounts, </font><font style="font-family:Times New Roman;font-size:10pt;">our discovered </font><font style="font-family:Times New Roman;font-size:10pt;">inability to obtain appropriate billing documentation </font><font style="font-family:Times New Roman;font-size:10pt;">or </font><font style="font-family:Times New Roman;font-size:10pt;">authorizations and other reasons unrelated to credit risk. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of </font><font style="font-family:Times New Roman;font-size:10pt;">over </font><font style="font-family:Times New Roman;font-size:10pt;">99</font><font style="font-family:Times New Roman;font-size:10pt;">%</font><font style="font-family:Times New Roman;font-size:10pt;"> on</font><font style="font-family:Times New Roman;font-size:10pt;"> Medicare claims, and record this estimate during the period in which services are rendered as an estimated revenue adjustment and a corresponding reduction to patient accounts receivable.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">Therefore, we believe that our reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In addition to revenue recognized on completed episodes, we also recognize a portion of revenue associated with episodes in progress. Episodes in progress are </font><font style="font-family:Times New Roman;font-size:10pt;">60</font><font style="font-family:Times New Roman;font-size:10pt;">-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. We estimate this revenue on a monthly basis based upon historical trends. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and our estimate of the average percentage complete based on visits performed. As of </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">, the difference between the cash received from Medicare for a request for anticipated payment (&#8220;RAP&#8221;) on episodes in progress and the associated estimated revenue was immaterial and, therefore, the resulting credits were recorded as a reduction to our outstanding pa</font><font style="font-family:Times New Roman;font-size:10pt;">tient accounts receivable in our condensed </font><font style="font-family:Times New Roman;font-size:10pt;">consolidated balance sheets for such periods. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;text-decoration:underline;margin-left:0px;">Non-Medicare Revenue </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Episodic-based Revenue. </font><font style="font-family:Times New Roman;font-size:10pt;">We recognize revenue in a similar manner as we recognize Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Non-episodic </font><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;">b</font><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;">ased Revenue. </font><font style="font-family:Times New Roman;font-size:10pt;">Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates, as applicable. Contractual adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue and are also recorded as a reduction to our outstanding patient accounts receivable. In addition, we receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Hospice Revenue Recognition </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;text-decoration:underline;margin-left:0px;">Hospice Medicare Revenue </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily or hourly rates for each of the four levels of care we deliver. The four levels of care</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">are routine care, general inpatient care, continuous home care and respite care. Routine care accounts </font><font style="font-family:Times New Roman;font-size:10pt;">for </font><font style="font-family:Times New Roman;font-size:10pt;">9</font><font style="font-family:Times New Roman;font-size:10pt;">6</font><font style="font-family:Times New Roman;font-size:10pt;">%</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">and </font><font style="font-family:Times New Roman;font-size:10pt;">100</font><font style="font-family:Times New Roman;font-size:10pt;">% </font><font style="font-family:Times New Roman;font-size:10pt;">of our total</font><font style="font-family:Times New Roman;font-size:10pt;"> Medicare hospice service revenue for the</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">three</font><font style="font-family:Times New Roman;font-size:10pt;">-month periods ended </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">and </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">, respectively</font><font style="font-family:Times New Roman;font-size:10pt;">,</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">9</font><font style="font-family:Times New Roman;font-size:10pt;">8</font><font style="font-family:Times New Roman;font-size:10pt;">% </font><font style="font-family:Times New Roman;font-size:10pt;">and 99% </font><font style="font-family:Times New Roman;font-size:10pt;">of our total</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">Medicare hospice service revenue for the </font><font style="font-family:Times New Roman;font-size:10pt;">nine</font><font style="font-family:Times New Roman;font-size:10pt;">-</font><font style="font-family:Times New Roman;font-size:10pt;">mon</font><font style="font-family:Times New Roman;font-size:10pt;">th</font><font style="font-family:Times New Roman;font-size:10pt;"> periods</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">ended </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">, respectively</font><font style="font-family:Times New Roman;font-size:10pt;">. </font><font style="font-family:Times New Roman;font-size:10pt;">We make adjustments to Medicare revenue for an inability to obtain appropriate billing documentation</font><font style="font-family:Times New Roman;font-size:10pt;"> or </font><font style="font-family:Times New Roman;font-size:10pt;">acceptable </font><font style="font-family:Times New Roman;font-size:10pt;">authorizations</font><font style="font-family:Times New Roman;font-size:10pt;"> and</font><font style="font-family:Times New Roman;font-size:10pt;"> other reasons unrelated to credit risk. We estimate the impact of these adjustments based on our historical experience, which primarily includes our historical collection rate on Medicare claims, and record it during the period services are rendered as an estimated revenue adjustment and as a reduction to our outstanding patient accounts receivable. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap for each provider number, we monitor these caps and estimate amounts due back to Medicare if a cap has been exceeded.&#160;We record these adjustments as a reduction to revenue and an increase in other accrued liabilities.&#160; We have settled our Medicare hospice reimbursements for all fiscal y</font><font style="font-family:Times New Roman;font-size:10pt;">ears through October 31, 20</font><font style="font-family:Times New Roman;font-size:10pt;">12 as of </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;">. </font><font style="font-family:Times New Roman;font-size:10pt;">As of </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30, 2014, we have recorded $</font><font style="font-family:Times New Roman;font-size:10pt;">2</font><font style="font-family:Times New Roman;font-size:10pt;">.</font><font style="font-family:Times New Roman;font-size:10pt;">8</font><font style="font-family:Times New Roman;font-size:10pt;"> million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2013 through October 31, 2014.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">As of December 31, 2013, we have recorded $4.0 million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2012 through October 31, 2014.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;text-decoration:underline;margin-left:0px;">Hospice Non-Medicare Revenue </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We record gross revenue on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per </font><font style="font-family:Times New Roman;font-size:10pt;">day </font><font style="font-family:Times New Roman;font-size:10pt;">rates, as applicable. Contractual adjustments are recorded for the difference between our established rates and the amounts estimated to be realizable from patients, third parties and others for services provided and are deducted from gross revenue to determine our net service revenue and patient accounts receiva</font><font style="font-family:Times New Roman;font-size:10pt;">ble.</font></p> 60 0.99 60 6 5 0.98 4100000 14 20 0.67 0.67 0.99 9100000 4000000 2800000 0.96 1.00 2500000 1400000 365 0.6 0.5 120 0.1 <p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Patient Accounts Receivable </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party </font><font style="font-family:Times New Roman;font-size:10pt;">payors</font><font style="font-family:Times New Roman;font-size:10pt;"> and patients. </font><font style="font-family:Times New Roman;font-size:10pt;">There is no single </font><font style="font-family:Times New Roman;font-size:10pt;">payor</font><font style="font-family:Times New Roman;font-size:10pt;">, other than </font><font style="font-family:Times New Roman;font-size:10pt;">Medicare, that accounts for more than </font><font style="font-family:Times New Roman;font-size:10pt;">10</font><font style="font-family:Times New Roman;font-size:10pt;">% of our total</font><font style="font-family:Times New Roman;font-size:10pt;"> outstanding patient receivables,</font><font style="font-family:Times New Roman;font-size:10pt;"> and thus we believe there are no other significant concentrations of receivables that would subject us to any significant credit risk in the collection of our patient accounts receivable. We fully reserve for accounts which are aged at </font><font style="font-family:Times New Roman;font-size:10pt;">36</font><font style="font-family:Times New Roman;font-size:10pt;">5</font><font style="font-family:Times New Roman;font-size:10pt;"> days or greater. We write off accounts on a monthly basis once we have exhausted our collection efforts and deem an account to be uncollectible. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We believe the credit risk associated with our Medicare </font><font style="font-family:Times New Roman;font-size:10pt;">accounts, which represent</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">6</font><font style="font-family:Times New Roman;font-size:10pt;">7</font><font style="font-family:Times New Roman;font-size:10pt;">% </font><font style="font-family:Times New Roman;font-size:10pt;">of our</font><font style="font-family:Times New Roman;font-size:10pt;"> net patient accounts receivable at </font><font style="font-family:Times New Roman;font-size:10pt;">September 30, 2014</font><font style="font-family:Times New Roman;font-size:10pt;"> and </font><font style="font-family:Times New Roman;font-size:10pt;">December 31, </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">, </font><font style="font-family:Times New Roman;font-size:10pt;">is limited due to our historical collection rate of over </font><font style="font-family:Times New Roman;font-size:10pt;">99</font><font style="font-family:Times New Roman;font-size:10pt;">% </font><font style="font-family:Times New Roman;font-size:10pt;">from Medicare and the fact that Medicare is a U.S. government </font><font style="font-family:Times New Roman;font-size:10pt;">payor</font><font style="font-family:Times New Roman;font-size:10pt;">. Accordingly, we do not record an allowance for doubtful accounts for our Medicare patient accounts receivable, which are recorded at their net realizable value after recording estimated revenue </font><font style="font-family:Times New Roman;font-size:10pt;">adjustments as discussed above. </font><font style="font-family:Times New Roman;font-size:10pt;">During the three </font><font style="font-family:Times New Roman;font-size:10pt;">and </font><font style="font-family:Times New Roman;font-size:10pt;">nine</font><font style="font-family:Times New Roman;font-size:10pt;">-</font><font style="font-family:Times New Roman;font-size:10pt;">month</font><font style="font-family:Times New Roman;font-size:10pt;"> periods</font><font style="font-family:Times New Roman;font-size:10pt;"> ended </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30</font><font style="font-family:Times New Roman;font-size:10pt;">, </font><font style="font-family:Times New Roman;font-size:10pt;">2014</font><font style="font-family:Times New Roman;font-size:10pt;">, we recorded </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">1.4</font><font style="font-family:Times New Roman;font-size:10pt;"> million and </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">4.</font><font style="font-family:Times New Roman;font-size:10pt;">1</font><font style="font-family:Times New Roman;font-size:10pt;"> million, respectively, in estimated revenue adjustments to Medicare as compared to </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">2.5</font><font style="font-family:Times New Roman;font-size:10pt;"> million and </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">9.1</font><font style="font-family:Times New Roman;font-size:10pt;"> million during the three and </font><font style="font-family:Times New Roman;font-size:10pt;">nine</font><font style="font-family:Times New Roman;font-size:10pt;">-month periods ended </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30, </font><font style="font-family:Times New Roman;font-size:10pt;">2013</font><font style="font-family:Times New Roman;font-size:10pt;">,</font><font style="font-family:Times New Roman;font-size:10pt;"> respectively.</font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We believe there is a certain level of credit risk associated with non-Medicare </font><font style="font-family:Times New Roman;font-size:10pt;">payors</font><font style="font-family:Times New Roman;font-size:10pt;">. To provide for our non-Medicare patient accounts receivable that could become uncollectible in the future, we establish an allowance for doubtful accounts to reduce the carrying amount to its estimated net realizable value.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Medicare Home Health </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for </font><font style="font-family:Times New Roman;font-size:10pt;">60</font><font style="font-family:Times New Roman;font-size:10pt;">% of our estimated payment for the initial episode at the start of care or </font><font style="font-family:Times New Roman;font-size:10pt;">50</font><font style="font-family:Times New Roman;font-size:10pt;">% of the estimated payment for any subsequent episodes of care contiguous with the first episode for a particular patient. The full amount of the episode is billed after the episode has been completed (&#8220;final billed&#8221;). The RAP received for that particular episode is then deducted from our final payment. If a final bill is not submitted within the greater of </font><font style="font-family:Times New Roman;font-size:10pt;">120</font><font style="font-family:Times New Roman;font-size:10pt;"> days from the start of the episode, or </font><font style="font-family:Times New Roman;font-size:10pt;">60</font><font style="font-family:Times New Roman;font-size:10pt;"> days from the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare from any other claims in process for that particular provider number. The RAP and final claim must then be re-submitted. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Medicare Hospice </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services t</font><font style="font-family:Times New Roman;font-size:10pt;">hat we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. </font><font style="font-family:Times New Roman;font-size:10pt;">Once each patient has been confirmed for eligibility, we will bill Medicare on a monthly basis for the services provided to the patient. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Non-Medicare Home Health and Hospice </font></p><p style='margin-top:4.5pt; margin-bottom:6pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient's eligibility for services with the applicable </font><font style="font-family:Times New Roman;font-size:10pt;">payor</font><font style="font-family:Times New Roman;font-size:10pt;">. 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margin-bottom:9pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;margin-left:0px;">6</font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;">. </font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;">COMMITMENTS AND CONTINGENCIES</font><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;"> </font></p><p style='margin-top:0pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Legal Proceedings </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We are involved in the following legal actions: </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">United States Senate Committee on Finance Inquiry </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On May 12, 2010, we received a letter of inquiry from the</font><font style="font-family:Times New Roman;font-size:10pt;"> Senate Finance Committee requesting documents and information relating to our policies and practices regarding home therapy visits and therapy utilization trends. </font><font style="font-family:Times New Roman;font-size:10pt;">A similar letter was sent to the other major publicly traded home health care companies.</font><font style="font-family:Times New Roman;font-size:10pt;"> We cooperated with the Committee with respect to this inquiry.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On October 3, 2011, the Committee publicly issued a report titled &#8220;Staff Report on Home Health and the Medicare Therapy Threshold.&#8221; The Committee recommended that the CMS &#8220;must move toward taking therapy out of the payment model.&#8221; We believe that the issuance of the report concludes the Committee's inquiry, but are not in a position to speculate on the potential for future legislative or oversight action by the Committee.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Securities Class Action Lawsuits </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On June&#160;10, 2010, a putative securities class action complaint was filed in the United States District Court for the Middle District of Louisiana (the &#8220;</font><font style="font-family:Times New Roman;font-size:10pt;">District </font><font style="font-family:Times New Roman;font-size:10pt;">Court&#8221;) against the Company and certain of our current and former senior executives. Additional putative securities class actions were filed in the Court on July&#160;14,&#160;July&#160;16, and July&#160;28, 2010.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On October&#160;22, 2010, the&#160;</font><font style="font-family:Times New Roman;font-size:10pt;">District </font><font style="font-family:Times New Roman;font-size:10pt;">Court&#160;issued an order consolidating the putative&#160;securities&#160;class action lawsuits&#160;and the Federal Derivative Actions (described immediately below) for pre-trial purposes.&#160;In the same order, the </font><font style="font-family:Times New Roman;font-size:10pt;">District </font><font style="font-family:Times New Roman;font-size:10pt;">Court&#160;appointed the Public Employees Retirement System of Mississippi and the Puerto Rico Teachers' Retirement System as co-lead plaintiffs (together, the &#8220;Co-Lead Plaintiffs&#8221;) for the putative class.&#160;On December&#160;10, 2010, the </font><font style="font-family:Times New Roman;font-size:10pt;">District </font><font style="font-family:Times New Roman;font-size:10pt;">Court also consolidated the ERISA class action lawsuit (described below) with the putative securities class actions and Federal Derivative Actions for pre-trial purposes.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On January&#160;18, 2011, the Co-Lead Plaintiffs filed an amended, consolidated&#160;class action complaint (the &#8220;Securities Complaint&#8221;) which supersedes the earlier-filed securities class action complaints.&#160;The Securities Complaint alleges that the defendants made false and/or misleading statements and failed to disclose material facts about our business, financial condition, operations and prospects, particularly relating to our policies and practices regarding home therapy visits under the Medicare home health prospective payment system and the related alleged impact on our business, financial condition, operations and prospects. The Securities Complaint seeks a determination that the action may be maintained as a class action on behalf of all persons who purchased the Company's securities between August&#160;2, 2005 and September&#160;28, 2010 and an unspecified amount of damages.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">All defendants moved to dismiss the Securities Complaint. On June&#160;28, 2012, the </font><font style="font-family:Times New Roman;font-size:10pt;">District </font><font style="font-family:Times New Roman;font-size:10pt;">Court granted the defendants' motion to dismiss the Securities Complaint. On July&#160;26, 2012, the Co-Lead Plaintiffs filed a motion for reconsideration, which the </font><font style="font-family:Times New Roman;font-size:10pt;">District </font><font style="font-family:Times New Roman;font-size:10pt;">Court denied on April&#160;9, 2013.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On May&#160;3, 2013, the Co-Lead Plaintiffs appealed the dismissal of the Securities Complaint to the United States Court of Appeals for the Fifth Circuit</font><font style="font-family:Times New Roman;font-size:10pt;"> (the &#8220;Fifth Circuit&#8221;)</font><font style="font-family:Times New Roman;font-size:10pt;">. </font><font style="font-family:Times New Roman;font-size:10pt;">On October 2, 2014, a three-judge panel of the Fifth Circuit issued a decision reversing the District Court's dismissal of the Securities Complaint. On October 16, 2014, all defendants filed a petition with the Fifth Circuit to review the three-judge panel's decision </font><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;">en</font><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;"> banc</font><font style="font-family:Times New Roman;font-size:10pt;">, or as a whole court. No assurances can be given as to the timing or outcome of the defendants' petition for </font><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;">en</font><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;"> banc</font><font style="font-family:Times New Roman;font-size:10pt;"> rehearing.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">ERISA Class Action Lawsuit </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On September&#160;27, 2010 and October&#160;22, 2010, separate putative class action complaints were filed in the United States District Court for the Middle District of Louisiana against the Company, certain of our current and former senior executives and members of our 401(k) Plan Administrative Committee.&#160;The suits allege</font><font style="font-family:Times New Roman;font-size:10pt;">d</font><font style="font-family:Times New Roman;font-size:10pt;"> violations of the Employee Retirement Income Security Act (&#8220;ERISA&#8221;) since January&#160;1, 2006 and July 1, 2007, respectively. The plaintiffs brought the complaints on behalf of themselves and a class of similarly situated participants in our 401(k) Plan.&#160;The plaintiffs assert</font><font style="font-family:Times New Roman;font-size:10pt;">ed</font><font style="font-family:Times New Roman;font-size:10pt;"> that the defendants breached their fiduciary duties to the 401(k) Plan's participants by causing the 401(k) Plan to offer and hold Amedisys common stock during the respective class periods when it was an allegedly unduly risky and imprudent retirement investment because of our alleged improper business practices.&#160;The complaints </font><font style="font-family:Times New Roman;font-size:10pt;">sought</font><font style="font-family:Times New Roman;font-size:10pt;"> a determination that the actions may be maintained as a class action, an award of unspecified monetary damages and other unspecified relief. As noted above, on December&#160;10, 2010, the Court consolidated the putative ERISA class actions with the putative securities class actions and derivative actions for pre-trial purposes. In addition, on December 10, 2010, the Court appointed interim lead counsel and interim liaison counsel in the ERISA class action. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On March 10, 2011, Wanda Corbin, Pia </font><font style="font-family:Times New Roman;font-size:10pt;">Galimba</font><font style="font-family:Times New Roman;font-size:10pt;"> and Linda Trammell (the &#8220;Co-ERISA Plaintiffs&#8221;), filed an amended, consolidated&#160;class action complaint (the &#8220;ERISA Complaint&#8221;), which supersede</font><font style="font-family:Times New Roman;font-size:10pt;">d</font><font style="font-family:Times New Roman;font-size:10pt;"> the earlier-filed ERISA class action complaints.&#160; The ERISA Complaint </font><font style="font-family:Times New Roman;font-size:10pt;">sought</font><font style="font-family:Times New Roman;font-size:10pt;"> a determination that the action may be maintained as a class action on behalf of themselves and a class of similarly situated participants in our 401(k) plan from January 1, 2008 through present. All of the defendants moved to dismiss the ERISA Complaint.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On November 5, 2013, we reached an agreement in principle to settle the ERISA class action lawsuits on a class-wide basis under which</font><font style="font-family:Calibri;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">we </font><font style="font-family:Times New Roman;font-size:10pt;">would make a payment of $1.2 million (which we correctly anticipated would be paid by our insurance carrier) and provide </font><font style="font-family:Times New Roman;font-size:10pt;">additional non-monetary benefits to 401(k) Plan participants. We then negotiated a formal settlement agreement with the Co-ERISA Plaintiffs and on December 13, 2013, submitted it to the Court for preliminary and final approval. The formal settlement agreement describe</font><font style="font-family:Times New Roman;font-size:10pt;">d</font><font style="font-family:Times New Roman;font-size:10pt;"> how the $1.2 million settlement payment would be allocated among the putative class of 401(k) Plan participants after certain expenses and fees </font><font style="font-family:Times New Roman;font-size:10pt;">were</font><font style="font-family:Times New Roman;font-size:10pt;"> deducted. On April 14, 2014, the Court granted the motion for preliminary approval and scheduled a final fairness hearing for July 22, 2014. Our insurance carrier funded the $1.2 million settlement pool shortly after the entry of the April 14, 2014 order. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On July 22, 2014, the Court conducted a fairness hearing. On July </font><font style="font-family:Times New Roman;font-size:10pt;">24,</font><font style="font-family:Times New Roman;font-size:10pt;"> 2014, the Court entered an order approving the settlement, dismissing the ERISA class action lawsuits with prejudice, certifying a settlement class and approving the release of all claims by the settlement class that were or could have been alleged in the matter.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">SEC Investigation </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On June&#160;30, 2010, we received notice of a formal investigation from the SEC and received a subpoena for documents relating to the matters under review by the United States Senate Committee on Finance and other matters involving our operations.</font><font style="font-family:Times New Roman;font-size:10pt;"> We cooperated with the SEC with respect to this investigation, and in June 2014 we were informed by the SEC staff that the investigation had been completed and that the staff did not intend to recommend any enforcement action by the SEC.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">U.S. Department of Justice Civil Investigative Demand (&#8220;CID&#8221;) Pursuant to False Claims Act and Stark Law Matters </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On September&#160;27, 2010, we received a CID issued by the U.S. Department of Justice pursuant to the federal False Claims Act. The CID requires the delivery of a wide range of documents and information relating to the Company's clinical and business operations, including reimbursement and billing claims submitted to Medicare for home health services, and related compliance activities. The CID generally covers the period from January&#160;1, 2003.&#160;On April&#160;26, 2011, we received a second CID related to the CID issued in September 2010, which generally covers the same time period as the previous CID and requires the production of additional documents. Such CIDs are often associated with previously filed qui tam actions, or lawsuits filed under seal under the False Claims Act (&#8220;FCA&#8221;), 31 U.S.C. &#167; 3729 et seq. Qui tam actions are brought by private plaintiffs suing on behalf of the federal government for alleged FCA violations. Subsequently, the Company and certain current and former employees received additional CIDs for additional documents and/or testimony. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In May 2012, we made a disclosure to CMS under the agency's Stark Law Self-Referral Disclosure Protocol relating to certain services agreements between a subsidiary of ours and a large physician group. During some period of time since December 2007, the arrangements appear not to have complied in certain respects with an applicable exemption to the Stark Law referral prohibition. Medicare revenue earned as a result of referrals from the physician group from May 2008 to May 2012, the relevant four year &#8220;</font><font style="font-family:Times New Roman;font-size:10pt;">lookback</font><font style="font-family:Times New Roman;font-size:10pt;">&#8221; period under the Stark Law Self-Referral Disclosure Protocol, was approximately $4 million. On January&#160;11, 2013, one of our subsidiaries received a CID from the United States Attorney's Office for the Northern District of Georgia seeking certain information relating to that subsidiary's relationship with this physician group. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On October 4, 2013, we reached an agreement in principle to resolve both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter. We agreed to this tentative settlement without any admission of wrongdoing to resolve these matters and to avoid the uncertainty and expense of protracted litigation. On April 23, 2014, we entered into a settlement agreement to resolve both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter. </font><font style="font-family:Times New Roman;font-size:10pt;">The settlement agreement contains no admissions of liability on our part. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Pursuant to the settlement agreement, </font><font style="font-family:Times New Roman;font-size:10pt;">on May 2, 2014, </font><font style="font-family:Times New Roman;font-size:10pt;">we paid</font><font style="font-family:Times New Roman;font-size:10pt;"> the United States an initial payment in the amount of $</font><font style="font-family:Times New Roman;font-size:10pt;">116.5</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">million</font><font style="font-family:Times New Roman;font-size:10pt;">,</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">representing the first installment of $115 million plus interest thereon due under the settlement agreement</font><font style="font-family:Times New Roman;font-size:10pt;">, and on October 23, 2014, we paid the United States an additional payment in the amount of </font><font style="font-family:Times New Roman;font-size:10pt;">$</font><font style="font-family:Times New Roman;font-size:10pt;">35.8</font><font style="font-family:Times New Roman;font-size:10pt;"> million, representing the s</font><font style="font-family:Times New Roman;font-size:10pt;">econd</font><font style="font-family:Times New Roman;font-size:10pt;"> and final </font><font style="font-family:Times New Roman;font-size:10pt;">installment of $35 million plus interest thereon </font><font style="font-family:Times New Roman;font-size:10pt;">due under the settlement agreement</font><font style="font-family:Times New Roman;font-size:10pt;">.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In consideration of our obligations under the settlement agreement and conditioned upon our full payment of the settlement amount, the United States agreed to release us from any civil or administrative monetary claim under the False Claims Act and various other statutes and legal theories for (a) claims involving home health services rendered by certain of our care centers from January 1, 2008 through December 31, 2010 that the United States contended were (</font><font style="font-family:Times New Roman;font-size:10pt;">i</font><font style="font-family:Times New Roman;font-size:10pt;">) provided to patients who were not homebound, (ii) provided to patients lacking a need for skilled nursing and/or skilled therapy services, (iii) provided to patients without regard to medical necessity, or (iv) overbilled by </font><font style="font-family:Times New Roman;font-size:10pt;">upcoding</font><font style="font-family:Times New Roman;font-size:10pt;"> patients' diagnoses, and (b) claims arising from our billings to the Medicare program during the period from April 1, 2008 through April 30, 2012 for home health services referred by a particular physician practice group while we were providing such practice group remuneration that was not consistent with fair market value in the form of patient care coordination services performed by our employees.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">The settlement agreement also resolve</font><font style="font-family:Times New Roman;font-size:10pt;">d</font><font style="font-family:Times New Roman;font-size:10pt;"> allegations made against us by various </font><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;">qui tam</font><font style="font-family:Times New Roman;font-size:10pt;"> relators, who </font><font style="font-family:Times New Roman;font-size:10pt;">were</font><font style="font-family:Times New Roman;font-size:10pt;"> required to dismiss their claims with prejudice. We </font><font style="font-family:Times New Roman;font-size:10pt;">were</font><font style="font-family:Times New Roman;font-size:10pt;"> required to pay various relators' attorneys' fees and expenses in the aggregate sum of approximately $3.9 million. </font><font style="font-family:Times New Roman;font-size:10pt;">In addition, we </font><font style="font-family:Times New Roman;font-size:10pt;">will</font><font style="font-family:Times New Roman;font-size:10pt;"> incur additional expenses </font><font style="font-family:Times New Roman;font-size:10pt;">in the future </font><font style="font-family:Times New Roman;font-size:10pt;">in connection with compliance measures mandated by the corporate integrity agreement discussed below. </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We have previously recorded an accrual for the settlement amount and add</font><font style="font-family:Times New Roman;font-size:10pt;">ed</font><font style="font-family:Times New Roman;font-size:10pt;"> the amount of the relators' attorneys' fees to this accrual in the quarter ended March 31, 2014.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In connection with the settlement agreement, on April 23, 2014, we entered into a corporate integrity agreement with the Office of </font><font style="font-family:Times New Roman;font-size:10pt;">Inspector General-HHS. The corporate integrity agreement formalizes various aspects of our already existing ethics and compliance programs and contains other requirements designed to help ensure our ongoing compliance with federal health care program requirements. Among other things, the corporate integrity agreement requires us to maintain our existing compliance program and compliance committee; provide certain compliance training; continue screening new and current employees against certain lists to ensure they are not ineligible to participate in federal health care programs; engage an independent review organization to perform certain auditing and reviews and prepare certain reports regarding our compliance with federal health care programs, our billing submissions to federal health care programs and our compliance and risk mitigation programs; and provide certain reports and management certifications to Office of Inspector General-HHS. Upon breach of the corporate integrity agreement, we could become liable for payment of certain stipulated penalties, or could be excluded from participation in federal health care programs. The corporate integrity agreement has a term of five years.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">OIG Self-Disclosure </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In October 2012, we made a disclosure to the Office of Counsel to the Inspector General of the United States Department of Health and Human Services (the &#8220;OIG&#8221;) pursuant to the OIG Provider Self-Disclosure Protocol regarding certain clinical documentation issues and eligibility regulatory requirements at two of our hospice care centers. These hospice care centers did not comply in some respects with certain state and Medicare hospice regulations including those requiring physicians to certify patient eligibility and requiring patient face-to-face encounters. We recorded an additional accrual of approximately $1 million during the three-month period ended September 30, 2013 increasing the total accrual to approximately $2 million as of September 30, 2013, where it remained at December 31, 2013. A final settlement agreement with OIG, pursuant to which we agreed to pay approximately $2 million to settle the matter, was executed on March 12, 2014.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In September and October 2013, we made preliminary disclosures to OIG under the OIG's Provider Self-Disclosure Protocol regarding certain clinical documentation issues at one of our home health care centers. This care center appears to have not complied with certain Medicare home health regulations, including those relating to physician signature requirements and face-to-face documentation. We made a disclosure in March 2014 to OIG providing additional information relating to the information disclosed in the preliminary disclosures sent in September and October 201</font><font style="font-family:Times New Roman;font-size:10pt;">3. </font><font style="font-family:Times New Roman;font-size:10pt;">As of </font><font style="font-family:Times New Roman;font-size:10pt;">June 30</font><font style="font-family:Times New Roman;font-size:10pt;">, 201</font><font style="font-family:Times New Roman;font-size:10pt;">4</font><font style="font-family:Times New Roman;font-size:10pt;">, we </font><font style="font-family:Times New Roman;font-size:10pt;">had </font><font style="font-family:Times New Roman;font-size:10pt;">recorded </font><font style="font-family:Times New Roman;font-size:10pt;">an accrual of approximately $</font><font style="font-family:Times New Roman;font-size:10pt;">1</font><font style="font-family:Times New Roman;font-size:10pt;">.</font><font style="font-family:Times New Roman;font-size:10pt;">9</font><font style="font-family:Times New Roman;font-size:10pt;"> million for this matter. A final settlement agreement with OIG pursuant to which we agreed to pay approximately $2</font><font style="font-family:Times New Roman;font-size:10pt;">.1</font><font style="font-family:Times New Roman;font-size:10pt;"> million to settle the matter was executed on September 9, 2014.</font><font style="font-family:Times New Roman;font-size:10pt;"> </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-style:italic;margin-left:0px;">Wage and Hour Litigation </font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On July 25, 2012, a putative collective and class action complaint was filed in the United States District Court for the District of Connecticut against us in which three former employees allege wage and hour law violations.&#160; The former employees claim that they were not paid overtime for all hours worked over forty hours in violation of the Federal Fair Labor Standards Act (&#8220;FLSA&#8221;), as well as the Pennsylvania Minimum Wage Act. More specifically, they allege they were paid on both a per-visit and an hourly basis, and that such a pay scheme resulted in their misclassification as exempt employees, thereby denying them overtime pay. Moreover, in response to a Company motion arguing that plaintiffs' complaint was deficient in that it was ambiguous and failed to provide fair notice of the claims asserted and plaintiffs' opposition thereto, the Court, on April 8, 2013, held that the complaint adequately raises general allegations that the plaintiffs were not paid overtime for all hours worked in a week over forty, which may include claims for unpaid overtime under other theories of liability, such as alleged off-the-clock work, in addition to plaintiffs' more clearly stated allegations based on misclassification. On behalf of themselves and a class of current and former employees they allege are similarly situated, plaintiffs seek attorneys' fees, back wages and liquidated damages going back three years under the FLSA and three years under the Pennsylvania statute. On October 8, 2013, the Court granted plaintiffs' motion for equitable tolling requesting that the statute of limitations for claims under the FLSA for plaintiffs who opt-in to the lawsuit be tolled from September 24, 2012, the date upon which plaintiffs filed their original motion for conditional certification, until 90 days after any notice of this lawsuit is issued following conditional certification. Following a motion for reconsideration filed by the Company, on December 3, 2013, the Court modified this order, holding that putative class members' FLSA claims are tolled from October 29, 2012 through the date of the Court's order on plaintiffs' motion for conditional certification. On January 13, 2014, the Court granted plaintiffs' July 10, 2013 motion for conditional certification of their FLSA claims and authorized issuance of notice to putative class members to provide them an opportunity to opt in to the action. On April 17, 2014, that notice was mailed to putative class members. </font><font style="font-family:Times New Roman;font-size:10pt;">The period within which putative class members were permitted to opt in to the action expired on July 16, 2014.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On September 10, 2014, the plaintiffs in the Connecticut case filed a motion for leave to amend their complaint to add a new claim under the Kentucky Wage and Hour Act (&#8220;KWHA&#8221;) alleging that the Company did not pay certain home health clinicians working in the Commonwealth of Kentucky all of the overtime wages they were owed, either because the Company misclassified them as exempt from overtime or, while treating them as overtime eligible, did not properly pay them overtime for all hours worked over 40 in a week. On behalf of themselves and a class of current and former employees they allege are similarly situated, plaintiffs seek attorneys' fees, back wages and liquidated damages going back five years before the filing of their original complaint under the KWHA. On October 1, 2014, the Company filed an opposition to the plaintiffs' motion to amend. On October 15, 2014, plaintiffs filed a reply </font><font style="font-family:Times New Roman;font-size:10pt;">brief in</font><font style="font-family:Times New Roman;font-size:10pt;"> support of their motion. The motion is still under consideration by the Court.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">On September 13, 2012, a putative collective and class action complaint was filed in the United States District Court for the Northern District of Illinois against us in which a former employee alleges wage and hour law violations.&#160; The former employee claims she was paid on both a per-visit and an hourly basis, thereby misclassifying her as an exempt employee and entitling her to overtime pay. The </font><font style="font-family:Times New Roman;font-size:10pt;">plaintiff alleges violations of Federal and state law and seeks damages under the FLSA and the Illinois Minimum Wage Law. &#160;Plaintiff seeks class certification of similar employees who were or are employed in Illinois and seeks attorneys' fees, back wages and liquidated damages going back three years under the FLSA and three years under the Illinois statute. On May 28, 2013, the Court granted the Company's motion to stay the case pending resolution of class certification issues and dispositive motions in the earlier-filed Con</font><font style="font-family:Times New Roman;font-size:10pt;">necticut case referenced above.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We are unable to assess the probable outcome or reasonably estimate the potential liab</font><font style="font-family:Times New Roman;font-size:10pt;">ility, if any, arising from the </font><font style="font-family:Times New Roman;font-size:10pt;">securities and</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">wage and hour litigation described above.&#160; The Company intends to continue to vigorously defend i</font><font style="font-family:Times New Roman;font-size:10pt;">tself in the securities and wage and </font><font style="font-family:Times New Roman;font-size:10pt;">hour litigation matters.&#160; No as</font><font style="font-family:Times New Roman;font-size:10pt;">surances can be given as to the </font><font style="font-family:Times New Roman;font-size:10pt;">timing or outcome of the securities and wage and hour matters described above or the impact of any of the inquiry or litigation matters on the Company, its consolidated financial condition, results of operations or cash flows, which could be material, individually or in the aggregate.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We recognize that additional putative securities class action complaints and other litigation could be filed, and that other investigations and actions could be commenced.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In addition to the matters referenced in this note, we are invo</font><font style="font-family:Times New Roman;font-size:10pt;">lved in legal actions in the normal course of business, some of which seek monetary damages, including claims for punitive damages. We do not believe that these normal course actions, when finally concluded and determined, will have a material impact on our consolidated financial condition, results of operations or cash flows.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Third Party Audits</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">From time to time, in the ordinary course of business, we are subject to audits under various governmental programs in which third party firms engaged by CMS conduct extensive review of claims data to identify potential improper payments under the Medicare program. </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In January 2010, our subsidiary that provides home health services in Dayton, Ohio received from a Medicare Program Safeguard Contractor (&#8220;PSC&#8221;) a request for records regarding 137 claims submitted by the subsidiary paid from January 2, 2008 through November 10, 2009 (the &#8220;Claim Period&#8221;) to determine whether the underlying services met pertinent Medicare payment requirements. Based on the PSC's findings for 114 of the claims, which were extrapolated to all claims for home health services provided by the Dayton subsidiary paid during the Claim Period, on March 9, 2011, the Medicare Administrative Contractor (&#8220;MAC&#8221;) for the subsidiary issued a notice of overpayment seeking recovery from our subsidiary of an alleged overpayment of approximately $5.6 million. We dispute these findings, and our Dayton subsidiary has filed appeals through the Original Medicare Standard Appeals Process, in which we are seeking to have those findings overturned. Most recently, a consolidated administrative law judge (&#8220;ALJ&#8221;) hearing was held in late March 2013. In January 2014, the ALJ found fully in favor of our Dayton subsidiary on 74 appeals and partially in favor of our Dayton subsidiary on eight appeals. Taking into account the ALJ's decision, certain determinations that our Dayton subsidiary decided not to appeal as well as certain determinations made by the MAC, of the 114 claims that were originally extrapolated by the MAC, 76 claims have now been decided in favor of our Dayton subsidiary in full, 10 claims have been decided in favor of our Dayton subsidiary in part, and 28 claims have been decided against or not appealed by our Dayton subsidiary. The ALJ has ordered the MAC to recalculate the extrapolation amount based on the ALJ's decision. The Medicare Appeals Council can decide on its own motion to review the ALJ's decisions. As of </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30</font><font style="font-family:Times New Roman;font-size:10pt;">, 2014, we have recorded no liability with respect to the pending appeals as we do not believe that an estimate of a reasonably possible loss or range of loss can be made at this time.</font></p><p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">In July 2010, our subsidiary that provides hospice services in Florence, South Carolina received from a Zone Program Integrity Contractor (&#8220;ZPIC&#8221;) a request for records regarding a sample of 30 beneficiaries who received services from the subsidiary during the period of January 1, 2008 through March 31, 2010 (the &#8220;Review Period&#8221;) to determine whether the underlying services met pertinent Medicare payment requirements.&#160; We acquired the hospice operations subject to this review on August 1, 2009; the Review Period covers time periods both before and after our ownership of these hospice operations.&#160; Based on the ZPIC's findings for 16 beneficiaries, which were extrapolated to all claims for hospice services provided by the Florence subsidiary billed during the Review Period, on June 6, 2011, the MAC for the subsidiary issued a notice of overpayment seeking recovery from our subsidiary of an alleged overpayment. We dispute these findings, and our Florence subsidiary has filed appeals through the Original Medicare Standard Appeals Process, in which we are seeking to have those findings overturned. Most recently, we have requested appeal hearings before an ALJ, </font><font style="font-family:Times New Roman;font-size:10pt;">which have been scheduled to occur on </font><font style="font-family:Times New Roman;font-size:10pt;">January 7</font><font style="font-family:Times New Roman;font-size:10pt;">, 201</font><font style="font-family:Times New Roman;font-size:10pt;">5</font><font style="font-family:Times New Roman;font-size:10pt;">, but</font><font style="font-family:Times New Roman;font-size:10pt;"> no assurances can be given as to the timing or outcome of the ALJ appeal. The current alleged extrapolated overpayment is $6.1 million. In the event we pay any amount of this alleged overpayment, we are indemnified by the prior owners of the hospice operations for amounts relating to the period prior to August 1, 2009. </font><font style="font-family:Times New Roman;font-size:10pt;">As of </font><font style="font-family:Times New Roman;font-size:10pt;">September</font><font style="font-family:Times New Roman;font-size:10pt;"> 30</font><font style="font-family:Times New Roman;font-size:10pt;">, 2014, we have recorded no liability for this claim</font><font style="font-family:Times New Roman;font-size:10pt;"> as we do not believe that an estimate of a reasonably possible loss or range of loss can be made at this time</font><font style="font-family:Times New Roman;font-size:10pt;">.</font></p><p style='margin-top: 0pt; margin-bottom: 0pt;'></p><p style='margin-top:12pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;font-weight:bold;font-style:italic;margin-left:0px;">Insurance </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">We are obligated for certain costs associated with our insurance programs, including employee health, workers' compensation and professional liability. 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Such estimates, and the resulting reserves, are reviewed and updated by us on a quarterly basis. </font><font style="font-family:Times New Roman;font-size:10pt;"> </font></p><p style='margin-top:4.5pt; margin-bottom:0pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Our </font><font style="font-family:Times New Roman;font-size:10pt;">health insurance has a retention limit of $</font><font style="font-family:Times New Roman;font-size:10pt;">0.9</font><font style="font-family:Times New Roman;font-size:10pt;"> million, our workers' compensation insurance has a retention limit of $</font><font style="font-family:Times New Roman;font-size:10pt;">0.5</font><font style="font-family:Times New Roman;font-size:10pt;"> million and our professional liability insurance has a retention limit of $</font><font style="font-family:Times New Roman;font-size:10pt;">0.3</font><font style="font-family:Times New Roman;font-size:10pt;"> </font><font style="font-family:Times New Roman;font-size:10pt;">million</font><font style="font-family:Times New Roman;font-size:10pt;">.</font></p> 900000 500000 300000 137 3 1 114 5600000 6100000 16 30 4000000 115000000 35000000 1200000 2000000 1000000 76 10 28 74 8 1900000 116500000 2000000 3900000 P5Y 35800000 2100000 <p style='margin-top:6pt; margin-bottom:0pt'><font style="font-family:Times New Roman Bold;font-size:10pt;font-weight:bold;margin-left:0px;">7</font><font style="font-family:Times New Roman Bold;font-size:10pt;font-weight:bold;">. Segment Information</font></p><p style='margin-top:9pt; margin-bottom:4.5pt'><font style="font-family:Times New Roman;font-size:10pt;margin-left:0px;">Our operations involve servicing patients through our two reportable business segments: home health and hospice. Our home health segment delivers a wide range of services in the homes of individuals who may be recovering from surgery, have a chronic disability or terminal illness or need assistance with the essential activities of daily living. Our hospice segment provides palliative care and comfort to terminally ill patients and their families. 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Long Term Debt (Detail) (USD $)
Sep. 30, 2014
Dec. 31, 2013
Debt Instrument [Line Items]    
Long-term debt including current portion $ 114,300,000 $ 46,900,000
Current portion of long-term obligations (12,000,000) (13,904,000)
Total 102,300,000 33,000,000
Revolving Credit Facilities [Member]
   
Debt Instrument [Line Items]    
Long-term debt including current portion 10,000,000 0
Term Loan [Member]
   
Debt Instrument [Line Items]    
Long-term debt including current portion 36,000,000 45,000,000
Promissory Notes [Member]
   
Debt Instrument [Line Items]    
Long-term debt including current portion 0 1,900,000
Second Lien Credit Agreement Term Loan [Member]
   
Debt Instrument [Line Items]    
Long-term debt including current portion 70,000,000 0
Discount on long-term debt $ (1,700,000) $ 0

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EXIT ACTIVITIES
9 Months Ended
Sep. 30, 2014
Restructuring and Related Activities  
EXIT ACTIVITIES

4. EXIT AND RESTRUCTURING ACTIVITIES

Exit Activity

As of December 31, 2013, we reported three home health care centers as held for sale. During the three-month period ended March 31, 2014, we sold assets associated with one of these care centers for cash consideration of approximately $0.6 million and recognized a gain of approximately $0.6 million which is included in discontinued operations. In addition, during the three months ended March 31, 2014, one of the care centers classified as held for sale as of December 31, 2013 was consolidated with a care center servicing the same market. During the three-month period ended June 30, 2014, we sold assets associated with the remaining care center for cash consideration of approximately $0.2 million and recognized a gain of approximately $0.2 million which is included in discontinued operations.

Effective April 17, 2014, the Company sold its interest in five home health and four hospice care centers in Wyoming and Idaho for approximately $5.0 million and recognized a gain of $2.1 million.

Effective September 5, 2014, the Company exited its hospice inpatient unit in New Hampshire and recognized a loss of $0.5 million.

In addition to the sale of the care centers mentioned above, during the three months ended March 31, 2014, we consolidated three home health care centers with care centers servicing the same markets and closed four home health care centers and one hospice care center and announced our plans to close or consolidate another 43 care centers. In connection with these care centers, we recorded non-cash charges of $2.2 million in other intangibles impairment expense related to the write-off of intangible assets, $2.1 million in other general and administrative expenses related to lease termination costs and $2.1 million in salaries and benefits related to severance costs during the three-month period ended March 31, 2014. These care centers were not concentrated in certain selected geographical areas and did not meet the criteria to be classified as discontinued operations in accordance with applicable accounting guidance. During the three-month period ended June 30, 2014, we completed the closure of the remaining 43 care centers as follows: we consolidated 18 home health care centers and four hospice care centers with care centers servicing the same markets and closed 18 home health care centers and three hospice care centers.

Restructuring Activity

During the quarter ended March 31, 2014, we restructured our regional leadership and corporate support functions. As such, we recorded charges of $3.4 million in salaries and benefits related to severance costs during the three-month period ended March 31, 2014. In addition, on February 20, 2014, William F. Borne stepped down from his positions as Chief Executive Officer, Chairman and a member of our Board of Directors and we recorded charges of $2.3 million in salaries and benefits related to severance costs.

 

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Segment Information - Additional Information (Detail)
9 Months Ended
Sep. 30, 2014
Segments
Segment Reporting [Abstract]  
Number of reportable business segments 2
XML 19 R28.htm IDEA: XBRL DOCUMENT v2.4.0.8
Commitments and Contigencies (Detail) (USD $)
3 Months Ended 4 Months Ended 9 Months Ended 10 Months Ended 49 Months Ended 9 Months Ended 7 Months Ended 10 Months Ended 3 Months Ended 9 Months Ended 22 Months Ended 2 Months Ended 1 Months Ended 6 Months Ended 9 Months Ended 3 Months Ended 9 Months Ended 27 Months Ended 5 Months Ended 3 Months Ended
Sep. 30, 2014
Mar. 31, 2014
Sep. 30, 2013
May 02, 2014
Sep. 30, 2014
Sep. 30, 2013
Oct. 23, 2014
May 31, 2012
Dec. 31, 2013
Sep. 13, 2012
Wage and Hour Litigation [Member]
Illinois [Member]
Employee
Jul. 25, 2012
Wage and Hour Litigation [Member]
Connecticut [Member]
Employee
Nov. 05, 2013
ERISA Class Action Lawsuit [Member]
Sep. 30, 2013
Home Health [Member]
Sep. 30, 2013
Home Health [Member]
Nov. 10, 2009
Home Health [Member]
Ohio [Member]
Claims
Mar. 09, 2011
Home Health [Member]
Extrapolated [Member]
Ohio [Member]
Claims
Jan. 31, 2014
Home Health [Member]
Unfavorable [Member]
Ohio [Member]
Claims
Jan. 31, 2014
Home Health [Member]
Favorable In Full [Member]
Ohio [Member]
Claims
Jan. 31, 2014
Home Health [Member]
Favorable In Part [Member]
Ohio [Member]
Claims
Jun. 30, 2014
Home Health [Member]
OIG Self-Disclosure [Member]
Sep. 09, 2014
Home Health [Member]
OIG Self-Disclosure [Member]
Sep. 30, 2013
Hospice [Member]
Sep. 30, 2013
Hospice [Member]
Mar. 31, 2010
Hospice [Member]
South Carolina [Member]
Beneficiary
Jun. 06, 2011
Hospice [Member]
Extrapolated [Member]
South Carolina [Member]
Beneficiary
Mar. 12, 2014
Hospice [Member]
OIG Self-Disclosure [Member]
Sep. 30, 2013
Hospice [Member]
OIG Self-Disclosure [Member]
Dec. 31, 2013
Hospice [Member]
OIG Self-Disclosure [Member]
Commitments and Contingencies Disclosure [Line Items]                                                        
Medicare Revenue               $ 4,000,000                                        
Number of former employees who filled a putative collective and class action complaint                   1 3                                  
Number of claims submitted by subsidiary                             137 114 28 76 10                  
Recovery amount of the overpayment made to the subsidiary                               5,600,000                 6,100,000      
Number of claims appealed                                   74 8                  
Health insurance retention limit         900,000                                              
Workers' compensation insurance retention limit         500,000                                              
Professional liability insurance retention limit         300,000                                              
Number of beneficiaries                                               30 16      
Loss Contingency, Settlement Agreement, Consideration                       1,200,000                 2,100,000         2,000,000    
U.S. Department Of Justice Settlement 0   150,000,000   0 150,000,000             0 0               0 0          
Payment Upon Execution Of U.S. Department Of Justice Settlement       116,500,000 115,000,000                                              
Final Payment Of U.S. Department Of Justice Settlement         35,000,000   35,800,000                                          
Accrued Charge Related To U.S. Department Of Justice Settlement 35,000,000       35,000,000       150,000,000                                      
Loss Contingency, Estimate of Possible Loss                                                       2,000,000
Loss Contingency Accrual                                       1,900,000             1,000,000  
Relators' Attorneys' Fees For U.S. Department of Justice Settlement   $ 3,900,000                                                    
Corporate Integrity Agreement Term         5 years                                              
XML 20 R30.htm IDEA: XBRL DOCUMENT v2.4.0.8
Operating Income of Reportable Segments (Detail) (USD $)
3 Months Ended 9 Months Ended
Sep. 30, 2014
Sep. 30, 2013
Sep. 30, 2014
Sep. 30, 2013
Segment Reporting Information [Line Items]        
Net service revenue $ 300,281,000 $ 301,285,000 $ 904,026,000 $ 945,847,000
Cost of service, excluding depreciation and amortization 170,159,000 175,233,000 519,686,000 538,660,000
General and administrative expenses 103,200,000 116,000,000 337,500,000 357,200,000
Provision for doubtful accounts 4,183,000 3,944,000 13,318,000 12,437,000
Depreciation and amortization 6,515,000 8,925,000 22,109,000 28,306,000
U.S. Department Of Justice Settlement 0 150,000,000 0 150,000,000
Other intangibles impairment charge 0 1,542,000 2,208,000 3,828,000
Operating expenses 284,033,000 455,511,000 894,790,000 1,090,456,000
Operating income (loss) 16,248,000 (154,226,000) 9,236,000 (144,609,000)
Home Health [Member]
       
Segment Reporting Information [Line Items]        
Net service revenue 237,200,000 236,800,000 717,400,000 749,300,000
Cost of service, excluding depreciation and amortization 137,400,000 140,700,000 420,700,000 434,500,000
General and administrative expenses 63,100,000 74,300,000 206,400,000 230,400,000
Provision for doubtful accounts 4,100,000 2,700,000 11,800,000 7,600,000
Depreciation and amortization 2,100,000 2,500,000 7,000,000 7,800,000
U.S. Department Of Justice Settlement   0   0
Other intangibles impairment charge 0 1,500,000 1,200,000 3,800,000
Operating expenses 206,700,000 221,700,000 647,100,000 684,100,000
Operating income (loss) 30,500,000 15,100,000 70,300,000 65,200,000
Hospice [Member]
       
Segment Reporting Information [Line Items]        
Net service revenue 63,100,000 64,500,000 186,600,000 196,500,000
Cost of service, excluding depreciation and amortization 32,800,000 34,500,000 99,000,000 104,200,000
General and administrative expenses 14,100,000 16,100,000 44,300,000 49,200,000
Provision for doubtful accounts 100,000 1,200,000 1,500,000 4,800,000
Depreciation and amortization 500,000 500,000 1,600,000 1,600,000
U.S. Department Of Justice Settlement   0   0
Other intangibles impairment charge 0 0 1,000,000 0
Operating expenses 47,500,000 52,300,000 147,400,000 159,800,000
Operating income (loss) 15,600,000 12,200,000 39,200,000 36,700,000
All Other Segments [Member]
       
Segment Reporting Information [Line Items]        
Net service revenue 0 0 0 0
Cost of service, excluding depreciation and amortization 0 0 0 0
General and administrative expenses 26,000,000 25,600,000 86,800,000 77,600,000
Provision for doubtful accounts 0 0 0 0
Depreciation and amortization 3,900,000 5,900,000 13,500,000 18,900,000
U.S. Department Of Justice Settlement   150,000,000   150,000,000
Other intangibles impairment charge 0 0 0 0
Operating expenses 29,900,000 181,500,000 100,300,000 246,500,000
Operating income (loss) $ (29,900,000) $ (181,500,000) $ (100,300,000) $ (246,500,000)
XML 21 R8.htm IDEA: XBRL DOCUMENT v2.4.0.8
DISCONTINUED OPERATIONS AND ASSETS HELD FOR SALE
9 Months Ended
Sep. 30, 2014
Discontinued Operation, Additional Disclosures [Abstract]  
DISCONTINUED OPERATIONS

3. DISCONTINUED OPERATIONS AND ASSETS HELD FOR SALE

As part of our management of our portfolio of care centers, we review each care center's current financial performance, market penetration, forecasted market growth and the impact of proposed CMS payment revisions. As a result of our review, we consolidated 41 home health care centers and five hospice care centers with care centers servicing the same markets, sold 19 home health care centers and one hospice care center and closed 10 home health care centers during 2013. We had previously classified 28 of these care centers as held for sale during 2013 and three care centers remained classified as held for sale at December 31, 2013. During the three-month period ended March 31, 2014, we sold assets associated with one of these care centers and consolidated one of these care centers with a care center servicing the same market. During the three-month period ended June 30, 2014, we sold assets associated with the remaining care center; there are no care centers classified as held for sale as of September 30, 2014. For additional information on the care centers consolidated with care centers servicing the same markets and the care centers sold, see Note 4 – Exit and Restructuring Activities.

               
Net revenues and operating results for the periods presented for the care centers classified as discontinued operations are as follows (dollars in millions):
               
    For the Three-Month Periods Ended September 30,  For the Nine-Month Periods Ended September 30,  
    2014  2013  2014  2013 
               
 Net revenues $0.0 $7.7 $(0.3) $27.2 
 Loss before income taxes  0.0  (1.2)  (0.3)  (2.7) 
 Income tax benefit  0.0  0.5  0.1  1.1 
 Discontinued operations, net of tax $0.0 $(0.7) $(0.2) $(1.6) 
XML 22 R2.htm IDEA: XBRL DOCUMENT v2.4.0.8
CONDENSED CONSOLIDATED BALANCE SHEETS (USD $)
In Thousands, unless otherwise specified
Sep. 30, 2014
Dec. 31, 2013
Current assets:    
Cash and cash equivalents $ 5,542 $ 17,303
Patient accounts receivable, net of allowance for doubtful accounts of $15,640 and $14,231 102,859 111,133
Prepaid expenses 11,303 10,669
Deferred income taxes 10,153 55,329
Other current assets 12,577 10,785
Assets held for sale 0 60
Total current assets 142,434 205,279
Property and equipment, net of accumulated depreciation of $142,066 and $129,891 141,419 159,025
Goodwill 205,587 208,915
Intangible assets, net of accumulated amortization of $25,370 and $25,133 34,096 36,690
Deferred income taxes 128,478 90,214
Other assets, net 30,199 26,283
Total assets 682,213 726,406
Current liabilities:    
Accounts payable 19,363 20,139
Accrued charge related to U.S. Department of Justice settlement 35,000 150,000
Payroll and employee benefits 71,208 70,801
Accrued expenses 53,494 57,572
Current portion of long-term obligations 12,000 13,904
Total current liabilities 191,065 312,416
Long-term obligations, less current portion 102,299 33,000
Other long-term obligations 5,748 8,511
Total liabilities 299,112 353,927
Commitments and Contingencies - Note 6 0 0
Equity:    
Preferred stock, $0.001 par value, 5,000,000 shares authorized; none issued or outstanding 0 0
Common stock, $0.001 par value, 60,000,000 shares authorized; 34,306,877 and 33,413,970 shares issued; and 33,347,852 and 32,538,971 shares outstanding 34 33
Additional paid-in capital 477,115 467,890
Treasury stock at cost 959,025 and 874,999 shares of common stock (19,483) (18,176)
Accumulated other comprehensive income 15 15
Retained earnings (73,920) (77,561)
Total Amedisys, Inc. stockholders' equity 383,761 372,201
Noncontrolling interests (660) 278
Total equity 383,101 372,479
Total liabilities and equity $ 682,213 $ 726,406
XML 23 R6.htm IDEA: XBRL DOCUMENT v2.4.0.8
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS
9 Months Ended
Sep. 30, 2014
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS

1. NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS

Amedisys, Inc., a Delaware corporation, and its consolidated subsidiaries (“Amedisys,” “we,” “us,” or “our”) are a multi-state provider of home health and hospice services with approximately 81% and 84% of our revenue derived from Medicare for the three-month periods ended September 30, 2014 and 2013, respectively, and approximately 82% and 84% our revenue derived from Medicare for the nine-month periods ended September 30, 2014 and 2013, respectively. As of September 30, 2014, we owned and operated 316 Medicare-certified home health care centers and 80 Medicare-certified hospice care centers in 34 states within the United States, the District of Columbia and Puerto Rico.

Basis of Presentation

In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting solely of normal recurring adjustments) necessary to present fairly our financial position, our results of operations and our cash flows in accordance with U.S. Generally Accepted Accounting Principles (“U.S. GAAP”). Our results of operations for the interim periods presented are not necessarily indicative of results of our operations for the entire year and have not been audited by our independent auditors.

Certain information and footnote disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted from the interim financial information presented. This report should be read in conjunction with our consolidated financial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 2013 as filed with the Securities and Exchange Commission (“SEC”) on March 12, 2014 (the “Form 10-K”), which includes information and disclosures not included herein.

Use of Estimates

Our accounting and reporting policies conform with U.S. GAAP. In preparing the unaudited condensed consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates.

Reclassifications and Comparability

Certain reclassifications have been made to prior period's financial statements in order to conform to the current period's presentation.

Principles of Consolidation

These unaudited condensed consolidated financial statements include the accounts of Amedisys, Inc., and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying unaudited condensed consolidated financial statements, and business combinations accounted for as purchases have been included in our unaudited condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain investments that are accounted for as set forth below.

Investments

We consolidate investments when the entity is a variable interest entity and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50%. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our condensed consolidated financial statements.

We account for investments in entities in which we have the ability to exercise significant influence under the equity method if we hold 50% or less of the voting stock and the entity is not a variable interest entity in which we are the primary beneficiary. The book value of investments that we accounted for under the equity method of accounting was $15.5 million as of September 30, 2014, and $11.9 million as of December 31, 2013. We account for investments in entities in which we have less than a 20% ownership interest under the cost method of accounting if we do not have the ability to exercise significant influence over the investee. The aggregate carrying amount of our cost method investment was $5.0 million as of September 30, 2014 and December 31, 2013.

XML 24 R22.htm IDEA: XBRL DOCUMENT v2.4.0.8
Discontinued Operations and Assets Held For Sale - Additional Information (Detail)
3 Months Ended 12 Months Ended
Jun. 30, 2014
Agencies
Mar. 31, 2014
Agencies
Dec. 31, 2013
Agencies
Sep. 30, 2014
Agencies
Home Health [Member]
       
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]        
Number of care centers consolidated 18 3 41  
Number of care centers closed 18 4 10  
Number of care centers available for sale     28  
Number of care centers sold     19  
Number of care centers available for sale at year end     3 0
Home Health [Member] | Available For Sale [Member]
       
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]        
Number of care centers consolidated   1    
Number of care centers sold 1 1    
Hospice [Member]
       
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]        
Number of care centers consolidated 4   5  
Number of care centers closed 3 1    
Number of care centers sold     1  
XML 25 R24.htm IDEA: XBRL DOCUMENT v2.4.0.8
Exit Activities (Detail) (USD $)
3 Months Ended 9 Months Ended 3 Months Ended 12 Months Ended 3 Months Ended 12 Months Ended 3 Months Ended 8 Months Ended
Mar. 31, 2014
Agencies
Sep. 30, 2014
Sep. 30, 2013
Jun. 30, 2014
Home Health [Member]
Agencies
Mar. 31, 2014
Home Health [Member]
Agencies
Dec. 31, 2013
Home Health [Member]
Agencies
Sep. 30, 2014
Home Health [Member]
Agencies
Jun. 30, 2014
Hospice [Member]
Agencies
Mar. 31, 2014
Hospice [Member]
Agencies
Dec. 31, 2013
Hospice [Member]
Agencies
Mar. 31, 2014
Lease Termination [Member]
Mar. 31, 2014
Intangibles Write Off [Member]
Mar. 31, 2014
Severance For Former Executive [Member]
Mar. 31, 2014
Severance For Regional Leadership And Corporate Support [Member]
Mar. 31, 2014
Severance For Exit Activities [Member]
Jun. 30, 2014
Available For Sale [Member]
Home Health [Member]
Agencies
Mar. 31, 2014
Available For Sale [Member]
Home Health [Member]
Agencies
Apr. 17, 2014
Wyoming and Idaho Care Centers [Member]
Apr. 17, 2014
Wyoming and Idaho Care Centers [Member]
Home Health [Member]
Agencies
Apr. 17, 2014
Wyoming and Idaho Care Centers [Member]
Hospice [Member]
Agencies
Sep. 05, 2014
Hospice Inpatient Unit [Member]
Agencies
Restructuring Cost and Reserve [Line Items]                                          
Other Restructuring Costs                     $ 2,100,000 $ 2,200,000 $ 2,300,000 $ 3,400,000 $ 2,100,000            
Gain on sale of care centers   2,967,000 1,808,000                         200,000 600,000 2,100,000     (500,000)
Proceeds from dispositions of care centers, net of cash sold   $ 4,233,000 $ 3,725,000                         $ 200,000 $ 600,000 $ 5,000,000      
Number of care centers available for sale           28                              
Number of care centers consolidated       18 3 41   4   5             1        
Number of care centers sold           19       1           1 1   5 4  
Number of care centers closed       18 4 10   3 1                       1
Number of care centers included in divestiture plan 43                                        
Number of care centers available for sale at year end           3 0                            
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SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
9 Months Ended
Sep. 30, 2014
Accounting Policies [Abstract]  
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

2. Summary of Significant Accounting Policies

Revenue Recognition

We earn net service revenue through our home health and hospice care centers by providing a variety of services almost exclusively in the homes of our patients. This net service revenue is earned and billed either on an episode of care basis, on a per visit basis or on a daily basis depending upon the payment terms and conditions established with each payor for services provided. We refer to home health revenue earned and billed on a 60-day episode of care as episodic-based revenue.

When we record our service revenue, we record it net of estimated revenue adjustments and contractual adjustments to reflect amounts we estimate to be realizable for services provided, as discussed below. We believe, based on information currently available to us and based on our judgment, that changes to one or more factors that impact the accounting estimates (such as our estimates related to revenue adjustments, contractual adjustments and episodes in progress) we make in determining net service revenue, which changes are likely to occur from period to period, will not materially impact our reported consolidated financial condition, results of operations, cash flows or our future financial results.

Home Health Revenue Recognition

Medicare Revenue

Net service revenue is recorded under the Medicare prospective payment system (“PPS”) based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if our patient's care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits was fewer than five; (c) a partial payment if our patient transferred to another provider or we received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required (with various incremental adjustments made for additional visits, with larger payment increases associated with the sixth, fourteenth and twentieth visit thresholds); (e) adjustments to payments if we are unable to perform periodic therapy assessments; (f) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (g) changes in the base episode payments established by the Medicare Program; (h) adjustments to the base episode payments for case mix and geographic wages; and (i) recoveries of overpayments. In addition, we make adjustments to Medicare revenue if we find that we are unable to produce appropriate documentation of a face to face encounter between the patient and physician.

We make adjustments to Medicare revenue to reflect differences between estimated and actual payment amounts, our discovered inability to obtain appropriate billing documentation or authorizations and other reasons unrelated to credit risk. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record this estimate during the period in which services are rendered as an estimated revenue adjustment and a corresponding reduction to patient accounts receivable. Therefore, we believe that our reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered.

In addition to revenue recognized on completed episodes, we also recognize a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. We estimate this revenue on a monthly basis based upon historical trends. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and our estimate of the average percentage complete based on visits performed. As of September 30, 2014 and 2013, the difference between the cash received from Medicare for a request for anticipated payment (“RAP”) on episodes in progress and the associated estimated revenue was immaterial and, therefore, the resulting credits were recorded as a reduction to our outstanding patient accounts receivable in our condensed consolidated balance sheets for such periods.

Non-Medicare Revenue

Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms.

Non-episodic based Revenue. Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates, as applicable. Contractual adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue and are also recorded as a reduction to our outstanding patient accounts receivable. In addition, we receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment.

Hospice Revenue Recognition

Hospice Medicare Revenue

Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily or hourly rates for each of the four levels of care we deliver. The four levels of care are routine care, general inpatient care, continuous home care and respite care. Routine care accounts for 96% and 100% of our total Medicare hospice service revenue for the three-month periods ended September 30, 2014 and 2013, respectively, and 98% and 99% of our total Medicare hospice service revenue for the nine-month periods ended September 30, 2014 and 2013, respectively. We make adjustments to Medicare revenue for an inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these adjustments based on our historical experience, which primarily includes our historical collection rate on Medicare claims, and record it during the period services are rendered as an estimated revenue adjustment and as a reduction to our outstanding patient accounts receivable.

Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap for each provider number, we monitor these caps and estimate amounts due back to Medicare if a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in other accrued liabilities.  We have settled our Medicare hospice reimbursements for all fiscal years through October 31, 2012 as of September 30, 2014. As of September 30, 2014, we have recorded $2.8 million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2013 through October 31, 2014. As of December 31, 2013, we have recorded $4.0 million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2012 through October 31, 2014.

Hospice Non-Medicare Revenue

We record gross revenue on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per day rates, as applicable. Contractual adjustments are recorded for the difference between our established rates and the amounts estimated to be realizable from patients, third parties and others for services provided and are deducted from gross revenue to determine our net service revenue and patient accounts receivable.

Patient Accounts Receivable

Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. There is no single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables, and thus we believe there are no other significant concentrations of receivables that would subject us to any significant credit risk in the collection of our patient accounts receivable. We fully reserve for accounts which are aged at 365 days or greater. We write off accounts on a monthly basis once we have exhausted our collection efforts and deem an account to be uncollectible.

We believe the credit risk associated with our Medicare accounts, which represent 67% of our net patient accounts receivable at September 30, 2014 and December 31, 2013, is limited due to our historical collection rate of over 99% from Medicare and the fact that Medicare is a U.S. government payor. Accordingly, we do not record an allowance for doubtful accounts for our Medicare patient accounts receivable, which are recorded at their net realizable value after recording estimated revenue adjustments as discussed above. During the three and nine-month periods ended September 30, 2014, we recorded $1.4 million and $4.1 million, respectively, in estimated revenue adjustments to Medicare as compared to $2.5 million and $9.1 million during the three and nine-month periods ended September 30, 2013, respectively.

We believe there is a certain level of credit risk associated with non-Medicare payors. To provide for our non-Medicare patient accounts receivable that could become uncollectible in the future, we establish an allowance for doubtful accounts to reduce the carrying amount to its estimated net realizable value.

Medicare Home Health

For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for 60% of our estimated payment for the initial episode at the start of care or 50% of the estimated payment for any subsequent episodes of care contiguous with the first episode for a particular patient. The full amount of the episode is billed after the episode has been completed (“final billed”). The RAP received for that particular episode is then deducted from our final payment. If a final bill is not submitted within the greater of 120 days from the start of the episode, or 60 days from the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare from any other claims in process for that particular provider number. The RAP and final claim must then be re-submitted.

Medicare Hospice

For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. Once each patient has been confirmed for eligibility, we will bill Medicare on a monthly basis for the services provided to the patient.

Non-Medicare Home Health and Hospice

For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient's eligibility for services with the applicable payor. Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor. Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk. We estimate an allowance for doubtful accounts based upon our assessment of historical and expected net collections, business and economic conditions, trends in payment and an evaluation of collectibility based upon the date that the service was provided. Based upon our best judgment, we believe the allowance for doubtful accounts adequately provides for accounts that will not be collected due to credit risk

Fair Value of Financial Instruments
            
The following details our financial instruments where the carrying value and the fair value differ (amounts in millions):
            
    Fair Value at Reporting Date Using
Financial Instrument Carrying Value as of September 30, 2014  Quoted Prices in Active Markets for Identical Items (Level 1)  Significant Other Observable Inputs (Level 2)  Significant Unobservable Inputs (Level 3)
Long-term obligations$114.3 $0 $115.4 $0

The estimates of the fair value of our long-term debt are based upon a discounted present value analysis of future cash flows. Due to the uncertainty in the capital and credit markets the actual rates that would be obtained to borrow under similar conditions could materially differ from the estimates we have used.

The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows:

  • Level 1 – Quoted prices in active markets for identical assets and liabilities.
  • Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.
  • Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities.

For our other financial instruments, including our cash and cash equivalents, patient accounts receivable, accounts payable and accrued expenses, we estimate the carrying amounts' approximate fair value. Our deferred compensation plan assets are recorded at fair value.

Weighted-Average Shares Outstanding

Net income (loss) per share attributable to Amedisys, Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calculate our basic and diluted net income (loss) attributable to Amedisys, Inc. common stockholders (amounts in thousands):

   For the Three-Month Periods Ended September 30, For the Nine-Month Periods Ended September 30,
   2014 2013 2014 2013
 Weighted average number of shares outstanding - basic32,468 31,505 32,194 31,102
 Effect of dilutive securities:       
  Stock options0 0 0 0
  Non-vested stock and stock units466 0 496 0
 Weighted average number of shares outstanding - diluted32,934 31,505 32,690 31,102
 Anti-dilutive securities51 682 107 640

Recently Issued Accounting Pronouncements

 

In April 2014, the FASB issued Accounting Standards Update (“ASU”) 2014-08, Presentation of Financial Statements (Topic 205) and Property, Plant, and Equipment (Topic 360): Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity changing the criteria for reporting discontinued operations. The ASU states that only those disposed components (or components held-for-sale) representing a strategic shift that have (or will have) a major effect on operations and financial results (or that are businesses or non-profit activities held-for-sale at acquisition) will be reported in discontinued operations. The ASU also required expanded disclosures about discontinued operations in the financial statement notes. The ASU is effective for disposals (or classifications as held-for-sale) that occur within annual periods beginning on or after December 15, 2014 and interim periods within those annual periods. Early application is permitted, but only for those disposals (or classifications as held-for-sale) that have not been reported in financial statements previously issued or available for issuance. We have chosen to early adopt this ASU and have applied the new criteria in determining the accounting treatment for the care centers exited during 2014.

 

In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606), which requires an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised goods or services to customers. The ASU will replace most existing revenue recognition guidance in U.S. GAAP when it becomes effective on January 1, 2017. Early application is not permitted. The standard permits the use of either the retrospective or cumulative effect transition method. The Company is evaluating the effect that ASU 2014-09 will have on its consolidated financial statements and related disclosures. The Company has not yet selected a transition method nor has it determined the effect of the standard on its ongoing financial reporting.

XML 28 R3.htm IDEA: XBRL DOCUMENT v2.4.0.8
CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) (USD $)
In Thousands, except Share data, unless otherwise specified
Sep. 30, 2014
Dec. 31, 2013
Patient accounts receivable, allowance for doubtful accounts $ 15,640 $ 14,231
Property and equipment, accumulated depreciation 142,066 129,891
Intangible assets, accumulated amortization $ 25,370 $ 25,133
Preferred stock, par value $ 0.001 $ 0.001
Preferred stock, shares authorized 5,000,000 5,000,000
Preferred stock, issued 0 0
Preferred stock, outstanding 0 0
Common stock, par value $ 0.001 $ 0.001
Common stock, shares authorized 60,000,000 60,000,000
Common stock, shares issued 34,306,877 33,413,970
Common stock, shares outstanding 33,347,852 32,538,971
Treasury stock at cost, shares 959,025 874,999
XML 29 R17.htm IDEA: XBRL DOCUMENT v2.4.0.8
SEGMENT INFORMATION (Tables)
9 Months Ended
Sep. 30, 2014
Segment Reporting [Abstract]  
Operating Income of Reportable Segments
  For the Three-Month Period Ended September 30, 2014 
   Home Health  Hospice  Other  Total 
 Net service revenue$237.2 $63.1 $0.0 $300.3 
 Cost of service, excluding depreciation and amortization 137.4  32.8  0.0  170.2 
 General and administrative expenses 63.1  14.1  26.0  103.2 
 Provision for doubtful accounts 4.1  0.1  0.0  4.2 
 Depreciation and amortization 2.1  0.5  3.9  6.5 
 Operating expenses 206.7  47.5  29.9  284.1 
 Operating income (loss)$30.5 $15.6 $(29.9) $16.2 
              
  For the Three-Month Period Ended September 30, 2013 
   Home Health  Hospice  Other  Total 
 Net service revenue$236.8 $64.5 $0.0 $301.3 
 Cost of service, excluding depreciation and amortization 140.7  34.5  0.0  175.2 
 General and administrative expenses 74.3  16.1  25.6  116.0 
 Provision for doubtful accounts 2.7  1.2  0.0  3.9 
 Depreciation and amortization 2.5  0.5  5.9  8.9 
 U.S. Department of Justice settlement 0.0  0.0  150.0  150.0 
 Other intangibles impairment charge 1.5  0.0  0.0  1.5 
 Operating expenses 221.7  52.3  181.5  455.5 
 Operating income (loss)$15.1 $12.2 $(181.5) $(154.2) 
              
  For the Nine-Month Period Ended September 30, 2014 
   Home Health  Hospice  Other  Total 
 Net service revenue$717.4 $186.6 $0.0 $904.0 
 Cost of service, excluding depreciation and amortization 420.7  99.0  0.0  519.7 
 General and administrative expenses 206.4  44.3  86.8  337.5 
 Provision for doubtful accounts 11.8  1.5  0.0  13.3 
 Depreciation and amortization 7.0  1.6  13.5  22.1 
 Other intangibles impairment charge 1.2  1.0  0.0  2.2 
 Operating expenses 647.1  147.4  100.3  894.8 
 Operating income (loss)$70.3 $39.2 $(100.3) $9.2 
              
  For the Nine-Month Period Ended September 30, 2013 
   Home Health  Hospice  Other  Total 
 Net service revenue$749.3 $196.5 $0.0 $945.8 
 Cost of service, excluding depreciation and amortization 434.5  104.2  0.0  538.7 
 General and administrative expenses 230.4  49.2  77.6  357.2 
 Provision for doubtful accounts 7.6  4.8  0.0  12.4 
 Depreciation and amortization 7.8  1.6  18.9  28.3 
 U.S. Department of Justice settlement 0.0  0.0  150.0  150.0 
 Other intangibles impairment charge 3.8  0.0  0.0  3.8 
 Operating expenses 684.1  159.8  246.5  1,090.4 
 Operating income (loss)$65.2 $36.7 $(246.5) $(144.6) 
XML 30 R1.htm IDEA: XBRL DOCUMENT v2.4.0.8
Document and Entity Information
9 Months Ended
Sep. 30, 2014
Oct. 24, 2014
Document Information [Line Items]    
Document Type 10-Q  
Amendment Flag false  
Document Period End Date Sep. 30, 2014  
Document Fiscal Year Focus 2014  
Document Fiscal Period Focus Q3  
Trading Symbol AMED  
Entity Registrant Name AMEDISYS INC  
Entity Central Index Key 0000896262  
Current Fiscal Year End Date --12-31  
Entity Filer Category Accelerated Filer  
Entity Common Stock, Shares Outstanding   33,380,425
XML 31 R18.htm IDEA: XBRL DOCUMENT v2.4.0.8
Nature of Operations Consolidation and Presentation of Financial Statements - Additional Information (Detail) (USD $)
In Millions, unless otherwise specified
3 Months Ended 9 Months Ended
Sep. 30, 2014
States
Sep. 30, 2013
Sep. 30, 2014
States
Sep. 30, 2013
Dec. 31, 2013
Organization And Nature Of Operations [Line Items]          
Percent Of Net Services Revenue Provided By Medicare 81.00% 84.00% 82.00% 84.00%  
Number Of States With Facilities 34   34    
Minimum percent ownership for controlling interest percent 50.00%   50.00%    
Equity Method Investment Aggregate Cost $ 15.5   $ 15.5   $ 11.9
Cost Method Investments $ 5.0   $ 5.0   $ 5.0
Maximum Percent Ownership For Equity Method Percent 50.00%   50.00%    
Maximum Percent Ownership For Cost Method Percent 20.00%   20.00%    
Home Health [Member]
         
Organization And Nature Of Operations [Line Items]          
Operating Care Centers 316   316    
Hospice [Member]
         
Organization And Nature Of Operations [Line Items]          
Operating Care Centers 80   80    
XML 32 R4.htm IDEA: XBRL DOCUMENT v2.4.0.8
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (USD $)
In Thousands, except Per Share data, unless otherwise specified
3 Months Ended 9 Months Ended
Sep. 30, 2014
Sep. 30, 2013
Sep. 30, 2014
Sep. 30, 2013
Net service revenue $ 300,281 $ 301,285 $ 904,026 $ 945,847
Cost of service, excluding depreciation and amortization 170,159 175,233 519,686 538,660
General and administrative expenses:        
Salaries and benefits 69,461 73,906 224,032 228,758
Non-cash compensation 1,697 1,653 3,197 4,933
Other 32,018 40,308 110,240 123,534
Provision for doubtful accounts 4,183 3,944 13,318 12,437
Depreciation and amortization 6,515 8,925 22,109 28,306
U.S. Department Of Justice Settlement 0 150,000 0 150,000
Other intangibles impairment charge 0 1,542 2,208 3,828
Operating expenses 284,033 455,511 894,790 1,090,456
Operating income (loss) 16,248 (154,226) 9,236 (144,609)
Other (expense) income:        
Interest income 24 18 46 40
Interest expense (2,990) (672) (5,603) (2,478)
Equity in earnings from equity investments 563 354 2,234 1,054
Miscellaneous, net 110 6,553 544 6,075
Total other (expense) income, net (2,293) 6,253 (2,779) 4,691
Income (loss) before income taxes 13,955 (147,973) 6,457 (139,918)
Income tax (expense) benefit (5,358) 56,928 (2,483) 53,736
Income (loss) from continuing operations 8,597 (91,045) 3,974 (86,182)
Discontinued operations, net of tax 0 (733) (216) (1,615)
Net income (loss) 8,597 (91,778) 3,758 (87,797)
Net (income) loss attributable to noncontrolling interests (158) 709 (117) 1,248
Net income (loss) attributable to Amedisys, Inc. 8,439 (91,069) 3,641 (86,549)
Basic earnings per common share:        
Income (loss) from continuing operations attributable to Amedisys, Inc. common stockholders $ 0.26 $ (2.87) $ 0.12 $ (2.73)
Discontinued operations, net of tax $ 0.00 $ (0.02) $ (0.01) $ (0.05)
Net income (loss) attributable to Amedisys, Inc. common stockholders $ 0.26 $ (2.89) $ 0.11 $ (2.78)
Weighted average shares outstanding 32,468 31,505 32,194 31,102
Diluted earnings per common share:        
Income (loss) from continuing operations attributable to Amedisys, Inc. common stockholders $ 0.26 $ (2.87) $ 0.12 $ (2.73)
Discontinued operations, net of tax $ 0.00 $ (0.02) $ (0.01) $ (0.05)
Net income (loss) attributable to Amedisys, Inc. common stockholders $ 0.26 $ (2.89) $ 0.11 $ (2.78)
Weighted average shares outstanding 32,934 31,505 32,690 31,102
Amounts attributable to Amedisys, Inc. common stockholders:        
Income (loss) from continuing operations 8,439 (90,336) 3,857 (84,934)
Discontinued operations, net of tax 0 (733) (216) (1,615)
Net income (loss) attributable to Amedisys, Inc. $ 8,439 $ (91,069) $ 3,641 $ (86,549)
XML 33 R12.htm IDEA: XBRL DOCUMENT v2.4.0.8
SEGMENT INFORMATION
9 Months Ended
Sep. 30, 2014
Segment Reporting [Abstract]  
SEGMENT INFORMATION

7. Segment Information

Our operations involve servicing patients through our two reportable business segments: home health and hospice. Our home health segment delivers a wide range of services in the homes of individuals who may be recovering from surgery, have a chronic disability or terminal illness or need assistance with the essential activities of daily living. Our hospice segment provides palliative care and comfort to terminally ill patients and their families. The “other” column in the following tables consists of costs relating to corporate support functions that are not directly attributable to a specific segment.

Management evaluates performance and allocates resources based on the operating income of the reportable segments, which includes an allocation of corporate expenses directly attributable to the specific segment and includes revenues and all other costs directly attributable to the specific segment. Corporate expenses consist of cost relating to our executive management and corporate and administrative support functions that are not directly attributable to a specific segment. Corporate and administrative support functions represent primarily information services, accounting, finance, billing and collections, legal, compliance, risk management, procurement, marketing, clinical administration, training, human resource benefits and administration. Segment assets are not reviewed by the company's chief operating decision maker and therefore are not disclosed below (amounts in millions).

 

  For the Three-Month Period Ended September 30, 2014 
   Home Health  Hospice  Other  Total 
 Net service revenue$237.2 $63.1 $0.0 $300.3 
 Cost of service, excluding depreciation and amortization 137.4  32.8  0.0  170.2 
 General and administrative expenses 63.1  14.1  26.0  103.2 
 Provision for doubtful accounts 4.1  0.1  0.0  4.2 
 Depreciation and amortization 2.1  0.5  3.9  6.5 
 Operating expenses 206.7  47.5  29.9  284.1 
 Operating income (loss)$30.5 $15.6 $(29.9) $16.2 
              
  For the Three-Month Period Ended September 30, 2013 
   Home Health  Hospice  Other  Total 
 Net service revenue$236.8 $64.5 $0.0 $301.3 
 Cost of service, excluding depreciation and amortization 140.7  34.5  0.0  175.2 
 General and administrative expenses 74.3  16.1  25.6  116.0 
 Provision for doubtful accounts 2.7  1.2  0.0  3.9 
 Depreciation and amortization 2.5  0.5  5.9  8.9 
 U.S. Department of Justice settlement 0.0  0.0  150.0  150.0 
 Other intangibles impairment charge 1.5  0.0  0.0  1.5 
 Operating expenses 221.7  52.3  181.5  455.5 
 Operating income (loss)$15.1 $12.2 $(181.5) $(154.2) 
              
  For the Nine-Month Period Ended September 30, 2014 
   Home Health  Hospice  Other  Total 
 Net service revenue$717.4 $186.6 $0.0 $904.0 
 Cost of service, excluding depreciation and amortization 420.7  99.0  0.0  519.7 
 General and administrative expenses 206.4  44.3  86.8  337.5 
 Provision for doubtful accounts 11.8  1.5  0.0  13.3 
 Depreciation and amortization 7.0  1.6  13.5  22.1 
 Other intangibles impairment charge 1.2  1.0  0.0  2.2 
 Operating expenses 647.1  147.4  100.3  894.8 
 Operating income (loss)$70.3 $39.2 $(100.3) $9.2 
              
  For the Nine-Month Period Ended September 30, 2013 
   Home Health  Hospice  Other  Total 
 Net service revenue$749.3 $196.5 $0.0 $945.8 
 Cost of service, excluding depreciation and amortization 434.5  104.2  0.0  538.7 
 General and administrative expenses 230.4  49.2  77.6  357.2 
 Provision for doubtful accounts 7.6  4.8  0.0  12.4 
 Depreciation and amortization 7.8  1.6  18.9  28.3 
 U.S. Department of Justice settlement 0.0  0.0  150.0  150.0 
 Other intangibles impairment charge 3.8  0.0  0.0  3.8 
 Operating expenses 684.1  159.8  246.5  1,090.4 
 Operating income (loss)$65.2 $36.7 $(246.5) $(144.6) 
XML 34 R11.htm IDEA: XBRL DOCUMENT v2.4.0.8
COMMITMENTS AND CONTINGENCIES
9 Months Ended
Sep. 30, 2014
Commitments and Contingencies Disclosure [Abstract]  
COMMITMENTS AND CONTINGENCIES

6. COMMITMENTS AND CONTINGENCIES

Legal Proceedings

We are involved in the following legal actions:

United States Senate Committee on Finance Inquiry

On May 12, 2010, we received a letter of inquiry from the Senate Finance Committee requesting documents and information relating to our policies and practices regarding home therapy visits and therapy utilization trends. A similar letter was sent to the other major publicly traded home health care companies. We cooperated with the Committee with respect to this inquiry.

On October 3, 2011, the Committee publicly issued a report titled “Staff Report on Home Health and the Medicare Therapy Threshold.” The Committee recommended that the CMS “must move toward taking therapy out of the payment model.” We believe that the issuance of the report concludes the Committee's inquiry, but are not in a position to speculate on the potential for future legislative or oversight action by the Committee.

Securities Class Action Lawsuits

On June 10, 2010, a putative securities class action complaint was filed in the United States District Court for the Middle District of Louisiana (the “District Court”) against the Company and certain of our current and former senior executives. Additional putative securities class actions were filed in the Court on July 14, July 16, and July 28, 2010.

On October 22, 2010, the District Court issued an order consolidating the putative securities class action lawsuits and the Federal Derivative Actions (described immediately below) for pre-trial purposes. In the same order, the District Court appointed the Public Employees Retirement System of Mississippi and the Puerto Rico Teachers' Retirement System as co-lead plaintiffs (together, the “Co-Lead Plaintiffs”) for the putative class. On December 10, 2010, the District Court also consolidated the ERISA class action lawsuit (described below) with the putative securities class actions and Federal Derivative Actions for pre-trial purposes.

On January 18, 2011, the Co-Lead Plaintiffs filed an amended, consolidated class action complaint (the “Securities Complaint”) which supersedes the earlier-filed securities class action complaints. The Securities Complaint alleges that the defendants made false and/or misleading statements and failed to disclose material facts about our business, financial condition, operations and prospects, particularly relating to our policies and practices regarding home therapy visits under the Medicare home health prospective payment system and the related alleged impact on our business, financial condition, operations and prospects. The Securities Complaint seeks a determination that the action may be maintained as a class action on behalf of all persons who purchased the Company's securities between August 2, 2005 and September 28, 2010 and an unspecified amount of damages.

All defendants moved to dismiss the Securities Complaint. On June 28, 2012, the District Court granted the defendants' motion to dismiss the Securities Complaint. On July 26, 2012, the Co-Lead Plaintiffs filed a motion for reconsideration, which the District Court denied on April 9, 2013.

On May 3, 2013, the Co-Lead Plaintiffs appealed the dismissal of the Securities Complaint to the United States Court of Appeals for the Fifth Circuit (the “Fifth Circuit”). On October 2, 2014, a three-judge panel of the Fifth Circuit issued a decision reversing the District Court's dismissal of the Securities Complaint. On October 16, 2014, all defendants filed a petition with the Fifth Circuit to review the three-judge panel's decision en banc, or as a whole court. No assurances can be given as to the timing or outcome of the defendants' petition for en banc rehearing.

ERISA Class Action Lawsuit

On September 27, 2010 and October 22, 2010, separate putative class action complaints were filed in the United States District Court for the Middle District of Louisiana against the Company, certain of our current and former senior executives and members of our 401(k) Plan Administrative Committee. The suits alleged violations of the Employee Retirement Income Security Act (“ERISA”) since January 1, 2006 and July 1, 2007, respectively. The plaintiffs brought the complaints on behalf of themselves and a class of similarly situated participants in our 401(k) Plan. The plaintiffs asserted that the defendants breached their fiduciary duties to the 401(k) Plan's participants by causing the 401(k) Plan to offer and hold Amedisys common stock during the respective class periods when it was an allegedly unduly risky and imprudent retirement investment because of our alleged improper business practices. The complaints sought a determination that the actions may be maintained as a class action, an award of unspecified monetary damages and other unspecified relief. As noted above, on December 10, 2010, the Court consolidated the putative ERISA class actions with the putative securities class actions and derivative actions for pre-trial purposes. In addition, on December 10, 2010, the Court appointed interim lead counsel and interim liaison counsel in the ERISA class action.

On March 10, 2011, Wanda Corbin, Pia Galimba and Linda Trammell (the “Co-ERISA Plaintiffs”), filed an amended, consolidated class action complaint (the “ERISA Complaint”), which superseded the earlier-filed ERISA class action complaints.  The ERISA Complaint sought a determination that the action may be maintained as a class action on behalf of themselves and a class of similarly situated participants in our 401(k) plan from January 1, 2008 through present. All of the defendants moved to dismiss the ERISA Complaint.

On November 5, 2013, we reached an agreement in principle to settle the ERISA class action lawsuits on a class-wide basis under which we would make a payment of $1.2 million (which we correctly anticipated would be paid by our insurance carrier) and provide additional non-monetary benefits to 401(k) Plan participants. We then negotiated a formal settlement agreement with the Co-ERISA Plaintiffs and on December 13, 2013, submitted it to the Court for preliminary and final approval. The formal settlement agreement described how the $1.2 million settlement payment would be allocated among the putative class of 401(k) Plan participants after certain expenses and fees were deducted. On April 14, 2014, the Court granted the motion for preliminary approval and scheduled a final fairness hearing for July 22, 2014. Our insurance carrier funded the $1.2 million settlement pool shortly after the entry of the April 14, 2014 order.

On July 22, 2014, the Court conducted a fairness hearing. On July 24, 2014, the Court entered an order approving the settlement, dismissing the ERISA class action lawsuits with prejudice, certifying a settlement class and approving the release of all claims by the settlement class that were or could have been alleged in the matter.

SEC Investigation

On June 30, 2010, we received notice of a formal investigation from the SEC and received a subpoena for documents relating to the matters under review by the United States Senate Committee on Finance and other matters involving our operations. We cooperated with the SEC with respect to this investigation, and in June 2014 we were informed by the SEC staff that the investigation had been completed and that the staff did not intend to recommend any enforcement action by the SEC.

U.S. Department of Justice Civil Investigative Demand (“CID”) Pursuant to False Claims Act and Stark Law Matters

On September 27, 2010, we received a CID issued by the U.S. Department of Justice pursuant to the federal False Claims Act. The CID requires the delivery of a wide range of documents and information relating to the Company's clinical and business operations, including reimbursement and billing claims submitted to Medicare for home health services, and related compliance activities. The CID generally covers the period from January 1, 2003. On April 26, 2011, we received a second CID related to the CID issued in September 2010, which generally covers the same time period as the previous CID and requires the production of additional documents. Such CIDs are often associated with previously filed qui tam actions, or lawsuits filed under seal under the False Claims Act (“FCA”), 31 U.S.C. § 3729 et seq. Qui tam actions are brought by private plaintiffs suing on behalf of the federal government for alleged FCA violations. Subsequently, the Company and certain current and former employees received additional CIDs for additional documents and/or testimony.

In May 2012, we made a disclosure to CMS under the agency's Stark Law Self-Referral Disclosure Protocol relating to certain services agreements between a subsidiary of ours and a large physician group. During some period of time since December 2007, the arrangements appear not to have complied in certain respects with an applicable exemption to the Stark Law referral prohibition. Medicare revenue earned as a result of referrals from the physician group from May 2008 to May 2012, the relevant four year “lookback” period under the Stark Law Self-Referral Disclosure Protocol, was approximately $4 million. On January 11, 2013, one of our subsidiaries received a CID from the United States Attorney's Office for the Northern District of Georgia seeking certain information relating to that subsidiary's relationship with this physician group.

On October 4, 2013, we reached an agreement in principle to resolve both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter. We agreed to this tentative settlement without any admission of wrongdoing to resolve these matters and to avoid the uncertainty and expense of protracted litigation. On April 23, 2014, we entered into a settlement agreement to resolve both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter. The settlement agreement contains no admissions of liability on our part.

Pursuant to the settlement agreement, on May 2, 2014, we paid the United States an initial payment in the amount of $116.5 million, representing the first installment of $115 million plus interest thereon due under the settlement agreement, and on October 23, 2014, we paid the United States an additional payment in the amount of $35.8 million, representing the second and final installment of $35 million plus interest thereon due under the settlement agreement.

In consideration of our obligations under the settlement agreement and conditioned upon our full payment of the settlement amount, the United States agreed to release us from any civil or administrative monetary claim under the False Claims Act and various other statutes and legal theories for (a) claims involving home health services rendered by certain of our care centers from January 1, 2008 through December 31, 2010 that the United States contended were (i) provided to patients who were not homebound, (ii) provided to patients lacking a need for skilled nursing and/or skilled therapy services, (iii) provided to patients without regard to medical necessity, or (iv) overbilled by upcoding patients' diagnoses, and (b) claims arising from our billings to the Medicare program during the period from April 1, 2008 through April 30, 2012 for home health services referred by a particular physician practice group while we were providing such practice group remuneration that was not consistent with fair market value in the form of patient care coordination services performed by our employees.

The settlement agreement also resolved allegations made against us by various qui tam relators, who were required to dismiss their claims with prejudice. We were required to pay various relators' attorneys' fees and expenses in the aggregate sum of approximately $3.9 million. In addition, we will incur additional expenses in the future in connection with compliance measures mandated by the corporate integrity agreement discussed below.

We have previously recorded an accrual for the settlement amount and added the amount of the relators' attorneys' fees to this accrual in the quarter ended March 31, 2014.

In connection with the settlement agreement, on April 23, 2014, we entered into a corporate integrity agreement with the Office of Inspector General-HHS. The corporate integrity agreement formalizes various aspects of our already existing ethics and compliance programs and contains other requirements designed to help ensure our ongoing compliance with federal health care program requirements. Among other things, the corporate integrity agreement requires us to maintain our existing compliance program and compliance committee; provide certain compliance training; continue screening new and current employees against certain lists to ensure they are not ineligible to participate in federal health care programs; engage an independent review organization to perform certain auditing and reviews and prepare certain reports regarding our compliance with federal health care programs, our billing submissions to federal health care programs and our compliance and risk mitigation programs; and provide certain reports and management certifications to Office of Inspector General-HHS. Upon breach of the corporate integrity agreement, we could become liable for payment of certain stipulated penalties, or could be excluded from participation in federal health care programs. The corporate integrity agreement has a term of five years.

OIG Self-Disclosure

In October 2012, we made a disclosure to the Office of Counsel to the Inspector General of the United States Department of Health and Human Services (the “OIG”) pursuant to the OIG Provider Self-Disclosure Protocol regarding certain clinical documentation issues and eligibility regulatory requirements at two of our hospice care centers. These hospice care centers did not comply in some respects with certain state and Medicare hospice regulations including those requiring physicians to certify patient eligibility and requiring patient face-to-face encounters. We recorded an additional accrual of approximately $1 million during the three-month period ended September 30, 2013 increasing the total accrual to approximately $2 million as of September 30, 2013, where it remained at December 31, 2013. A final settlement agreement with OIG, pursuant to which we agreed to pay approximately $2 million to settle the matter, was executed on March 12, 2014.

In September and October 2013, we made preliminary disclosures to OIG under the OIG's Provider Self-Disclosure Protocol regarding certain clinical documentation issues at one of our home health care centers. This care center appears to have not complied with certain Medicare home health regulations, including those relating to physician signature requirements and face-to-face documentation. We made a disclosure in March 2014 to OIG providing additional information relating to the information disclosed in the preliminary disclosures sent in September and October 2013. As of June 30, 2014, we had recorded an accrual of approximately $1.9 million for this matter. A final settlement agreement with OIG pursuant to which we agreed to pay approximately $2.1 million to settle the matter was executed on September 9, 2014.

Wage and Hour Litigation

On July 25, 2012, a putative collective and class action complaint was filed in the United States District Court for the District of Connecticut against us in which three former employees allege wage and hour law violations.  The former employees claim that they were not paid overtime for all hours worked over forty hours in violation of the Federal Fair Labor Standards Act (“FLSA”), as well as the Pennsylvania Minimum Wage Act. More specifically, they allege they were paid on both a per-visit and an hourly basis, and that such a pay scheme resulted in their misclassification as exempt employees, thereby denying them overtime pay. Moreover, in response to a Company motion arguing that plaintiffs' complaint was deficient in that it was ambiguous and failed to provide fair notice of the claims asserted and plaintiffs' opposition thereto, the Court, on April 8, 2013, held that the complaint adequately raises general allegations that the plaintiffs were not paid overtime for all hours worked in a week over forty, which may include claims for unpaid overtime under other theories of liability, such as alleged off-the-clock work, in addition to plaintiffs' more clearly stated allegations based on misclassification. On behalf of themselves and a class of current and former employees they allege are similarly situated, plaintiffs seek attorneys' fees, back wages and liquidated damages going back three years under the FLSA and three years under the Pennsylvania statute. On October 8, 2013, the Court granted plaintiffs' motion for equitable tolling requesting that the statute of limitations for claims under the FLSA for plaintiffs who opt-in to the lawsuit be tolled from September 24, 2012, the date upon which plaintiffs filed their original motion for conditional certification, until 90 days after any notice of this lawsuit is issued following conditional certification. Following a motion for reconsideration filed by the Company, on December 3, 2013, the Court modified this order, holding that putative class members' FLSA claims are tolled from October 29, 2012 through the date of the Court's order on plaintiffs' motion for conditional certification. On January 13, 2014, the Court granted plaintiffs' July 10, 2013 motion for conditional certification of their FLSA claims and authorized issuance of notice to putative class members to provide them an opportunity to opt in to the action. On April 17, 2014, that notice was mailed to putative class members. The period within which putative class members were permitted to opt in to the action expired on July 16, 2014.

On September 10, 2014, the plaintiffs in the Connecticut case filed a motion for leave to amend their complaint to add a new claim under the Kentucky Wage and Hour Act (“KWHA”) alleging that the Company did not pay certain home health clinicians working in the Commonwealth of Kentucky all of the overtime wages they were owed, either because the Company misclassified them as exempt from overtime or, while treating them as overtime eligible, did not properly pay them overtime for all hours worked over 40 in a week. On behalf of themselves and a class of current and former employees they allege are similarly situated, plaintiffs seek attorneys' fees, back wages and liquidated damages going back five years before the filing of their original complaint under the KWHA. On October 1, 2014, the Company filed an opposition to the plaintiffs' motion to amend. On October 15, 2014, plaintiffs filed a reply brief in support of their motion. The motion is still under consideration by the Court.

On September 13, 2012, a putative collective and class action complaint was filed in the United States District Court for the Northern District of Illinois against us in which a former employee alleges wage and hour law violations.  The former employee claims she was paid on both a per-visit and an hourly basis, thereby misclassifying her as an exempt employee and entitling her to overtime pay. The plaintiff alleges violations of Federal and state law and seeks damages under the FLSA and the Illinois Minimum Wage Law.  Plaintiff seeks class certification of similar employees who were or are employed in Illinois and seeks attorneys' fees, back wages and liquidated damages going back three years under the FLSA and three years under the Illinois statute. On May 28, 2013, the Court granted the Company's motion to stay the case pending resolution of class certification issues and dispositive motions in the earlier-filed Connecticut case referenced above.

We are unable to assess the probable outcome or reasonably estimate the potential liability, if any, arising from the securities and wage and hour litigation described above.  The Company intends to continue to vigorously defend itself in the securities and wage and hour litigation matters.  No assurances can be given as to the timing or outcome of the securities and wage and hour matters described above or the impact of any of the inquiry or litigation matters on the Company, its consolidated financial condition, results of operations or cash flows, which could be material, individually or in the aggregate.

We recognize that additional putative securities class action complaints and other litigation could be filed, and that other investigations and actions could be commenced.

In addition to the matters referenced in this note, we are involved in legal actions in the normal course of business, some of which seek monetary damages, including claims for punitive damages. We do not believe that these normal course actions, when finally concluded and determined, will have a material impact on our consolidated financial condition, results of operations or cash flows.

Third Party Audits

From time to time, in the ordinary course of business, we are subject to audits under various governmental programs in which third party firms engaged by CMS conduct extensive review of claims data to identify potential improper payments under the Medicare program.

In January 2010, our subsidiary that provides home health services in Dayton, Ohio received from a Medicare Program Safeguard Contractor (“PSC”) a request for records regarding 137 claims submitted by the subsidiary paid from January 2, 2008 through November 10, 2009 (the “Claim Period”) to determine whether the underlying services met pertinent Medicare payment requirements. Based on the PSC's findings for 114 of the claims, which were extrapolated to all claims for home health services provided by the Dayton subsidiary paid during the Claim Period, on March 9, 2011, the Medicare Administrative Contractor (“MAC”) for the subsidiary issued a notice of overpayment seeking recovery from our subsidiary of an alleged overpayment of approximately $5.6 million. We dispute these findings, and our Dayton subsidiary has filed appeals through the Original Medicare Standard Appeals Process, in which we are seeking to have those findings overturned. Most recently, a consolidated administrative law judge (“ALJ”) hearing was held in late March 2013. In January 2014, the ALJ found fully in favor of our Dayton subsidiary on 74 appeals and partially in favor of our Dayton subsidiary on eight appeals. Taking into account the ALJ's decision, certain determinations that our Dayton subsidiary decided not to appeal as well as certain determinations made by the MAC, of the 114 claims that were originally extrapolated by the MAC, 76 claims have now been decided in favor of our Dayton subsidiary in full, 10 claims have been decided in favor of our Dayton subsidiary in part, and 28 claims have been decided against or not appealed by our Dayton subsidiary. The ALJ has ordered the MAC to recalculate the extrapolation amount based on the ALJ's decision. The Medicare Appeals Council can decide on its own motion to review the ALJ's decisions. As of September 30, 2014, we have recorded no liability with respect to the pending appeals as we do not believe that an estimate of a reasonably possible loss or range of loss can be made at this time.

In July 2010, our subsidiary that provides hospice services in Florence, South Carolina received from a Zone Program Integrity Contractor (“ZPIC”) a request for records regarding a sample of 30 beneficiaries who received services from the subsidiary during the period of January 1, 2008 through March 31, 2010 (the “Review Period”) to determine whether the underlying services met pertinent Medicare payment requirements.  We acquired the hospice operations subject to this review on August 1, 2009; the Review Period covers time periods both before and after our ownership of these hospice operations.  Based on the ZPIC's findings for 16 beneficiaries, which were extrapolated to all claims for hospice services provided by the Florence subsidiary billed during the Review Period, on June 6, 2011, the MAC for the subsidiary issued a notice of overpayment seeking recovery from our subsidiary of an alleged overpayment. We dispute these findings, and our Florence subsidiary has filed appeals through the Original Medicare Standard Appeals Process, in which we are seeking to have those findings overturned. Most recently, we have requested appeal hearings before an ALJ, which have been scheduled to occur on January 7, 2015, but no assurances can be given as to the timing or outcome of the ALJ appeal. The current alleged extrapolated overpayment is $6.1 million. In the event we pay any amount of this alleged overpayment, we are indemnified by the prior owners of the hospice operations for amounts relating to the period prior to August 1, 2009. As of September 30, 2014, we have recorded no liability for this claim as we do not believe that an estimate of a reasonably possible loss or range of loss can be made at this time.

Insurance

We are obligated for certain costs associated with our insurance programs, including employee health, workers' compensation and professional liability. While we maintain various insurance programs to cover these risks, we are self-insured for a substantial portion of our potential claims. We recognize our obligations associated with these costs, up to specified deductible limits in the period in which a claim is incurred, including with respect to both reported claims and claims incurred but not reported. These costs have generally been estimated based on historical data of our claims experience. Such estimates, and the resulting reserves, are reviewed and updated by us on a quarterly basis.

Our health insurance has a retention limit of $0.9 million, our workers' compensation insurance has a retention limit of $0.5 million and our professional liability insurance has a retention limit of $0.3 million.

XML 35 R23.htm IDEA: XBRL DOCUMENT v2.4.0.8
Schedule of Net Revenues and Operating Results (Detail) (USD $)
3 Months Ended 9 Months Ended
Sep. 30, 2014
Sep. 30, 2013
Sep. 30, 2014
Sep. 30, 2013
Discontinued Operation, Additional Disclosures [Abstract]        
Net revenues $ 0 $ 7,700,000 $ (300,000) $ 27,200,000
Loss before income taxes 0 (1,200,000) (300,000) (2,700,000)
Income tax benefit 0 500,000 100,000 1,100,000
Discontinued operations, net of tax $ 0 $ (733,000) $ (216,000) $ (1,615,000)
XML 36 R19.htm IDEA: XBRL DOCUMENT v2.4.0.8
Summary of Significant Accounting Policies - Additional Information (Detail) (USD $)
In Millions, unless otherwise specified
3 Months Ended 9 Months Ended 12 Months Ended
Sep. 30, 2014
Sep. 30, 2013
Sep. 30, 2014
D
Number_of_Visits
Sep. 30, 2013
Dec. 31, 2013
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]          
Episode of care as episodic-based revenue, days     60    
Percentage of total reimbursement of outlier payment     10.00%    
Low utilization payment adjustment, maximum number of visits     5    
First threshold of therapy services required, visits     6    
Second threshold of services required, visits     14    
Third threshold of therapy services required, visits     20    
Historical collection rate from Medicare     99.00%    
Episodes in progress that begin during reporting period, days     60    
Hospice Medicare revenue rate accounted for routine care 96.00% 100.00% 98.00% 99.00%  
Percentage of patient receivables outstanding     10.00%    
Minimum days for accounts receivable outstanding to be fully reserved     365    
Portion of accounts receivable derived from Medicare     67.00%   67.00%
Revenue adjustment to Medicare revenue $ 1.4 $ 2.5 $ 4.1 $ 9.1  
Rate of request for anticipated payment submitted for the initial episode of care     60.00%    
Rate of request for anticipated payment submitted for subsequent episodes of care     50.00%    
Maximum days to submit final bill from the start of episode     120    
Maximum days to submit final bill from the date the request for anticipated payment was paid     60    
Cap Year Two Thousand Twelve Through Two Thousand Fourteen [Member]
         
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]          
Estimated amounts due back to Medicare         4.0
Cap Year Two Thousand Thirteen Through Two Thousand Fourteen [Member]
         
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]          
Estimated amounts due back to Medicare $ 2.8   $ 2.8    
XML 37 R15.htm IDEA: XBRL DOCUMENT v2.4.0.8
DISONTINUED OPERATIONS AND ASSETS HELD FOR SALE (Tables)
9 Months Ended
Sep. 30, 2014
Discontinued Operation, Additional Disclosures [Abstract]  
Net Revenues and Operating Results
               
Net revenues and operating results for the periods presented for the care centers classified as discontinued operations are as follows (dollars in millions):
               
    For the Three-Month Periods Ended September 30,  For the Nine-Month Periods Ended September 30,  
    2014  2013  2014  2013 
               
 Net revenues $0.0 $7.7 $(0.3) $27.2 
 Loss before income taxes  0.0  (1.2)  (0.3)  (2.7) 
 Income tax benefit  0.0  0.5  0.1  1.1 
 Discontinued operations, net of tax $0.0 $(0.7) $(0.2) $(1.6) 
XML 38 R13.htm IDEA: XBRL DOCUMENT v2.4.0.8
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS (Policies)
9 Months Ended
Sep. 30, 2014
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
Basis of Presentation

Basis of Presentation

In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting solely of normal recurring adjustments) necessary to present fairly our financial position, our results of operations and our cash flows in accordance with U.S. Generally Accepted Accounting Principles (“U.S. GAAP”). Our results of operations for the interim periods presented are not necessarily indicative of results of our operations for the entire year and have not been audited by our independent auditors.

Certain information and footnote disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted from the interim financial information presented. This report should be read in conjunction with our consolidated financial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 2013 as filed with the Securities and Exchange Commission (“SEC”) on March 12, 2014 (the “Form 10-K”), which includes information and disclosures not included herein.

Use of Estimates

Use of Estimates

Our accounting and reporting policies conform with U.S. GAAP. In preparing the unaudited condensed consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates.

Reclassifications and Comparability

Reclassifications and Comparability

Certain reclassifications have been made to prior period's financial statements in order to conform to the current period's presentation.

 

Principles of Consolidation

Principles of Consolidation

These unaudited condensed consolidated financial statements include the accounts of Amedisys, Inc., and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying unaudited condensed consolidated financial statements, and business combinations accounted for as purchases have been included in our unaudited condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain investments that are accounted for as set forth below.

Equity Investments

Investments

We consolidate investments when the entity is a variable interest entity and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50%. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our condensed consolidated financial statements.

We account for investments in entities in which we have the ability to exercise significant influence under the equity method if we hold 50% or less of the voting stock and the entity is not a variable interest entity in which we are the primary beneficiary. The book value of investments that we accounted for under the equity method of accounting was $15.5 million as of September 30, 2014, and $11.9 million as of December 31, 2013. We account for investments in entities in which we have less than a 20% ownership interest under the cost method of accounting if we do not have the ability to exercise significant influence over the investee. The aggregate carrying amount of our cost method investment was $5.0 million as of September 30, 2014 and December 31, 2013.

Revenue Recognition

Revenue Recognition

We earn net service revenue through our home health and hospice care centers by providing a variety of services almost exclusively in the homes of our patients. This net service revenue is earned and billed either on an episode of care basis, on a per visit basis or on a daily basis depending upon the payment terms and conditions established with each payor for services provided. We refer to home health revenue earned and billed on a 60-day episode of care as episodic-based revenue.

When we record our service revenue, we record it net of estimated revenue adjustments and contractual adjustments to reflect amounts we estimate to be realizable for services provided, as discussed below. We believe, based on information currently available to us and based on our judgment, that changes to one or more factors that impact the accounting estimates (such as our estimates related to revenue adjustments, contractual adjustments and episodes in progress) we make in determining net service revenue, which changes are likely to occur from period to period, will not materially impact our reported consolidated financial condition, results of operations, cash flows or our future financial results.

Home Health Revenue Recognition

Medicare Revenue

Net service revenue is recorded under the Medicare prospective payment system (“PPS”) based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if our patient's care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits was fewer than five; (c) a partial payment if our patient transferred to another provider or we received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required (with various incremental adjustments made for additional visits, with larger payment increases associated with the sixth, fourteenth and twentieth visit thresholds); (e) adjustments to payments if we are unable to perform periodic therapy assessments; (f) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (g) changes in the base episode payments established by the Medicare Program; (h) adjustments to the base episode payments for case mix and geographic wages; and (i) recoveries of overpayments. In addition, we make adjustments to Medicare revenue if we find that we are unable to produce appropriate documentation of a face to face encounter between the patient and physician.

We make adjustments to Medicare revenue to reflect differences between estimated and actual payment amounts, our discovered inability to obtain appropriate billing documentation or authorizations and other reasons unrelated to credit risk. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record this estimate during the period in which services are rendered as an estimated revenue adjustment and a corresponding reduction to patient accounts receivable. Therefore, we believe that our reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered.

In addition to revenue recognized on completed episodes, we also recognize a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. We estimate this revenue on a monthly basis based upon historical trends. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and our estimate of the average percentage complete based on visits performed. As of September 30, 2014 and 2013, the difference between the cash received from Medicare for a request for anticipated payment (“RAP”) on episodes in progress and the associated estimated revenue was immaterial and, therefore, the resulting credits were recorded as a reduction to our outstanding patient accounts receivable in our condensed consolidated balance sheets for such periods.

Non-Medicare Revenue

Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms.

Non-episodic based Revenue. Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates, as applicable. Contractual adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue and are also recorded as a reduction to our outstanding patient accounts receivable. In addition, we receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment.

Hospice Revenue Recognition

Hospice Medicare Revenue

Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily or hourly rates for each of the four levels of care we deliver. The four levels of care are routine care, general inpatient care, continuous home care and respite care. Routine care accounts for 96% and 100% of our total Medicare hospice service revenue for the three-month periods ended September 30, 2014 and 2013, respectively, and 98% and 99% of our total Medicare hospice service revenue for the nine-month periods ended September 30, 2014 and 2013, respectively. We make adjustments to Medicare revenue for an inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these adjustments based on our historical experience, which primarily includes our historical collection rate on Medicare claims, and record it during the period services are rendered as an estimated revenue adjustment and as a reduction to our outstanding patient accounts receivable.

Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap for each provider number, we monitor these caps and estimate amounts due back to Medicare if a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in other accrued liabilities.  We have settled our Medicare hospice reimbursements for all fiscal years through October 31, 2012 as of September 30, 2014. As of September 30, 2014, we have recorded $2.8 million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2013 through October 31, 2014. As of December 31, 2013, we have recorded $4.0 million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2012 through October 31, 2014.

Hospice Non-Medicare Revenue

We record gross revenue on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per day rates, as applicable. Contractual adjustments are recorded for the difference between our established rates and the amounts estimated to be realizable from patients, third parties and others for services provided and are deducted from gross revenue to determine our net service revenue and patient accounts receivable.

Patient Accounts Receivable

Patient Accounts Receivable

Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. There is no single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables, and thus we believe there are no other significant concentrations of receivables that would subject us to any significant credit risk in the collection of our patient accounts receivable. We fully reserve for accounts which are aged at 365 days or greater. We write off accounts on a monthly basis once we have exhausted our collection efforts and deem an account to be uncollectible.

We believe the credit risk associated with our Medicare accounts, which represent 67% of our net patient accounts receivable at September 30, 2014 and December 31, 2013, is limited due to our historical collection rate of over 99% from Medicare and the fact that Medicare is a U.S. government payor. Accordingly, we do not record an allowance for doubtful accounts for our Medicare patient accounts receivable, which are recorded at their net realizable value after recording estimated revenue adjustments as discussed above. During the three and nine-month periods ended September 30, 2014, we recorded $1.4 million and $4.1 million, respectively, in estimated revenue adjustments to Medicare as compared to $2.5 million and $9.1 million during the three and nine-month periods ended September 30, 2013, respectively.

We believe there is a certain level of credit risk associated with non-Medicare payors. To provide for our non-Medicare patient accounts receivable that could become uncollectible in the future, we establish an allowance for doubtful accounts to reduce the carrying amount to its estimated net realizable value.

Medicare Home Health

For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for 60% of our estimated payment for the initial episode at the start of care or 50% of the estimated payment for any subsequent episodes of care contiguous with the first episode for a particular patient. The full amount of the episode is billed after the episode has been completed (“final billed”). The RAP received for that particular episode is then deducted from our final payment. If a final bill is not submitted within the greater of 120 days from the start of the episode, or 60 days from the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare from any other claims in process for that particular provider number. The RAP and final claim must then be re-submitted.

Medicare Hospice

For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. Once each patient has been confirmed for eligibility, we will bill Medicare on a monthly basis for the services provided to the patient.

Non-Medicare Home Health and Hospice

For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient's eligibility for services with the applicable payor. Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor. Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk. We estimate an allowance for doubtful accounts based upon our assessment of historical and expected net collections, business and economic conditions, trends in payment and an evaluation of collectibility based upon the date that the service was provided. Based upon our best judgment, we believe the allowance for doubtful accounts adequately provides for accounts that will not be collected due to credit risk.

Fair Value of Financial Instruments
Fair Value of Financial Instruments
            
The following details our financial instruments where the carrying value and the fair value differ (amounts in millions):
            
    Fair Value at Reporting Date Using
Financial Instrument Carrying Value as of September 30, 2014  Quoted Prices in Active Markets for Identical Items (Level 1)  Significant Other Observable Inputs (Level 2)  Significant Unobservable Inputs (Level 3)
Long-term obligations$114.3 $0 $115.4 $0

The estimates of the fair value of our long-term debt are based upon a discounted present value analysis of future cash flows. Due to the uncertainty in the capital and credit markets the actual rates that would be obtained to borrow under similar conditions could materially differ from the estimates we have used.

The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows:

  • Level 1 – Quoted prices in active markets for identical assets and liabilities.
  • Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.
  • Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities.

For our other financial instruments, including our cash and cash equivalents, patient accounts receivable, accounts payable and accrued expenses, we estimate the carrying amounts' approximate fair value. Our deferred compensation plan assets are recorded at fair value.

Weighted-Average Shares Outstanding

Weighted-Average Shares Outstanding

Net income (loss) per share attributable to Amedisys, Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calculate our basic and diluted net income (loss) attributable to Amedisys, Inc. common stockholders (amounts in thousands):

   For the Three-Month Periods Ended September 30, For the Nine-Month Periods Ended September 30,
   2014 2013 2014 2013
 Weighted average number of shares outstanding - basic32,468 31,505 32,194 31,102
 Effect of dilutive securities:       
  Stock options0 0 0 0
  Non-vested stock and stock units466 0 496 0
 Weighted average number of shares outstanding - diluted32,934 31,505 32,690 31,102
 Anti-dilutive securities51 682 107 640
Recently Issued Accounting Pronouncements

Recently Issued Accounting Pronouncements

 

In April 2014, the FASB issued Accounting Standards Update (“ASU”) 2014-08, Presentation of Financial Statements (Topic 205) and Property, Plant, and Equipment (Topic 360): Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity changing the criteria for reporting discontinued operations. The ASU states that only those disposed components (or components held-for-sale) representing a strategic shift that have (or will have) a major effect on operations and financial results (or that are businesses or non-profit activities held-for-sale at acquisition) will be reported in discontinued operations. The ASU also required expanded disclosures about discontinued operations in the financial statement notes. The ASU is effective for disposals (or classifications as held-for-sale) that occur within annual periods beginning on or after December 15, 2014 and interim periods within those annual periods. Early application is permitted, but only for those disposals (or classifications as held-for-sale) that have not been reported in financial statements previously issued or available for issuance. We have chosen to early adopt this ASU and have applied the new criteria in determining the accounting treatment for the care centers exited during 2014.

 

In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606), which requires an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised goods or services to customers. The ASU will replace most existing revenue recognition guidance in U.S. GAAP when it becomes effective on January 1, 2017. Early application is not permitted. The standard permits the use of either the retrospective or cumulative effect transition method. The Company is evaluating the effect that ASU 2014-09 will have on its consolidated financial statements and related disclosures. The Company has not yet selected a transition method nor has it determined the effect of the standard on its ongoing financial reporting.

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SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)
9 Months Ended
Sep. 30, 2014
Accounting Policies [Abstract]  
Financial Instruments Where Carrying Value and Fair Value Differ
Fair Value of Financial Instruments
            
The following details our financial instruments where the carrying value and the fair value differ (amounts in millions):
            
    Fair Value at Reporting Date Using
Financial Instrument Carrying Value as of September 30, 2014  Quoted Prices in Active Markets for Identical Items (Level 1)  Significant Other Observable Inputs (Level 2)  Significant Unobservable Inputs (Level 3)
Long-term obligations$114.3 $0 $115.4 $0
Weighted-Average Shares Outstanding

The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calculate our basic and diluted net income (loss) attributable to Amedisys, Inc. common stockholders (amounts in thousands):

   For the Three-Month Periods Ended September 30, For the Nine-Month Periods Ended September 30,
   2014 2013 2014 2013
 Weighted average number of shares outstanding - basic32,468 31,505 32,194 31,102
 Effect of dilutive securities:       
  Stock options0 0 0 0
  Non-vested stock and stock units466 0 496 0
 Weighted average number of shares outstanding - diluted32,934 31,505 32,690 31,102
 Anti-dilutive securities51 682 107 640
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LONG-TERM OBLIGATIONS (Tables)
9 Months Ended
Sep. 30, 2014
Debt Disclosure [Abstract]  
Long-Term Debt
5. LONG-TERM OBLIGATIONS
        
Long-term debt consisted of the following for the periods indicated (amounts in millions):
        
    September 30, 2014  December 31, 2013
$60.0 million Term Loan; $3.0 million principal payments plus accrued interest payable quarterly; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (3.41% at September 30, 2014); due October 26, 2017 $36.0 $45.0
$120.0 million Revolving Credit Facility; interest only quarterly payments; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (3.41% at September 30, 2014); due October 26, 2017  10.0  0.0
$70.0 million Second Lien Loan; interest only quarterly payments; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (8.50% at September 30, 2014); due July 28, 2020  70.0  0.0
Discount on Second Lien Loan  (1.7)  0.0
Promissory notes  0.0  1.9
    114.3  46.9
Current portion of long-term obligations  (12.0)  (13.9)
 Total $102.3 $33.0
        
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Schedule of Weighted Average Shares Outstanding (Detail)
In Thousands, unless otherwise specified
3 Months Ended 9 Months Ended
Sep. 30, 2014
Sep. 30, 2013
Sep. 30, 2014
Sep. 30, 2013
Accounting Policies [Abstract]        
Weighted average number of shares outstanding - basic 32,468 31,505 32,194 31,102
Stock options 0 0 0 0
Non-vested stock and stock units 466 0 496 0
Weighted average number of shares outstanding - diluted 32,934 31,505 32,690 31,102
Anti-dilutive securities 51 682 107 640
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Long Term Debt - Additional Information (Detail) (USD $)
In Millions, unless otherwise specified
9 Months Ended 3 Months Ended 9 Months Ended 3 Months Ended 7 Months Ended 9 Months Ended
Sep. 30, 2014
Jul. 28, 2014
Jun. 30, 2014
Dec. 31, 2013
Sep. 30, 2014
Revolving Credit Facilities [Member]
Oct. 29, 2014
Revolving Credit Facilities [Member]
Jul. 28, 2014
Revolving Credit Facilities [Member]
Dec. 31, 2013
Revolving Credit Facilities [Member]
Sep. 30, 2014
Term Loan [Member]
Sep. 30, 2013
Term Loan [Member]
Sep. 30, 2014
Term Loan [Member]
Sep. 30, 2013
Term Loan [Member]
Dec. 31, 2013
Term Loan [Member]
Sep. 30, 2014
Promissory Notes [Member]
Dec. 31, 2013
Promissory Notes [Member]
Sep. 30, 2014
Second Lien Credit Agreement Term Loan [Member]
Jul. 28, 2014
Second Lien Credit Agreement Term Loan [Member]
Sep. 30, 2014
Second Lien Credit Agreement Term Loan [Member]
Dec. 31, 2013
Second Lien Credit Agreement Term Loan [Member]
Debt Instrument [Line Items]                                      
Term loan, period                     5 years                
Weighted-average interest rate for debt                 3.40% 2.70% 3.40% 2.70%       8.50%      
Total leverage ratio 2.1                                    
Fixed charge coverage ratio 1.8                                    
Principal amount         $ 120.0   $ 120.0   $ 60.0   $ 60.0         $ 70.0 $ 70.0 $ 70.0  
Availability under the revolving credit facility           55.7                          
Outstanding letters of credit           19.3                          
Credit facility, maximum borrowing capacity   120.0 165.0                                
Maturity date         Oct. 26, 2017           Oct. 26, 2017             Jul. 28, 2020  
Debt Instrument Periodic Payment Principal                     3.0                
Long-term debt including current portion 114.3     46.9 10.0     0 36.0   36.0   45.0 0 1.9 70.0   70.0 0
Proceeds From Issuance Of Debt                                 $ 67.4    
Senior Secured Leverage Ratio 1.2                                    
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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $)
In Thousands, unless otherwise specified
9 Months Ended
Sep. 30, 2014
Sep. 30, 2013
Cash Flows from Operating Activities:    
Net income (loss) $ 3,758 $ (87,797)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:    
Depreciation and amortization 22,149 28,730
Provision for doubtful accounts 13,392 12,853
Non-cash compensation 3,197 4,933
401(k) employer match 4,682 6,200
Loss on disposal of property and equipment 4,174 1,239
Gain on sale of care centers (2,967) (1,808)
Deferred income taxes 6,357 (53,611)
Write off of deferred debt issuance costs 488 0
Equity in earnings of equity investments (2,234) (1,054)
Amortization of deferred debt issuance costs 521 548
Return on equity investment 1,500 975
Other intangibles impairment charge 2,208 3,828
Changes in operating assets and liabilities, net of impact of acquisitions:    
Patient accounts receivable (5,848) 45,170
Other current assets (1,885) 1,409
Other assets 1,554 (2,069)
Accounts payable 668 (8,111)
U.S. Department of Justice settlement accrual (115,000) 150,000
Accrued expenses (4,081) (11,198)
Other long-term obligations (2,762) 3,625
Net cash (used in) provided by operating activities (70,129) 93,862
Cash Flows from Investing Activities:    
Proceeds from sale of deferred compensation plan assets 9 128
Proceeds from the sale of property and equipment 3 126
Purchases of deferred compensation plan assets (104) (93)
Purchases of property and equipment (9,882) (28,983)
Purchases of investments (3,421) (9,732)
Acquisitions of businesses, net of cash acquired 0 (627)
Proceeds from dispositions of care centers, net of cash sold 4,233 3,725
Net cash used in investing activities (9,162) (35,456)
Cash Flows from Financing Activities:    
Proceeds from issuance of stock upon exercise of stock options 89 258
Proceeds from issuance of stock to employee stock purchase plan 1,875 2,436
Non-controlling interest distribution 0 (163)
Proceeds from revolving line of credit 200,800 25,500
Repayments of revolving line of credit (190,800) (25,500)
Proceeds from issuance of long-term obligations 67,371 0
Debt issuance costs (901) 0
Principal payments of long-term obligations (10,904) (31,856)
Net cash provided by (used in) financing activities 67,530 (29,325)
Net (decrease) increase in cash and cash equivalents (11,761) 29,081
Cash and cash equivalents at beginning of period 17,303 14,545
Cash and cash equivalents at end of period 5,542 43,626
Supplemental Disclosures of Cash Flow Information:    
Cash paid for interest 4,771 2,384
Cash paid for income taxes, net of refunds received 13 3,235
Supplemental Disclosures of Non-Cash Financing and Investing Activities    
(Sale) acquisition of non-controlling interests $ (1,549) $ 312
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LONG-TERM OBLIGATIONS
9 Months Ended
Sep. 30, 2014
Debt Disclosure [Abstract]  
LONG-TERM OBLIGATIONS
5. LONG-TERM OBLIGATIONS
        
Long-term debt consisted of the following for the periods indicated (amounts in millions):
        
    September 30, 2014  December 31, 2013
$60.0 million Term Loan; $3.0 million principal payments plus accrued interest payable quarterly; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (3.41% at September 30, 2014); due October 26, 2017 $36.0 $45.0
$120.0 million Revolving Credit Facility; interest only quarterly payments; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (3.41% at September 30, 2014); due October 26, 2017  10.0  0.0
$70.0 million Second Lien Loan; interest only quarterly payments; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (8.50% at September 30, 2014); due July 28, 2020  70.0  0.0
Discount on Second Lien Loan  (1.7)  0.0
Promissory notes  0.0  1.9
    114.3  46.9
Current portion of long-term obligations  (12.0)  (13.9)
 Total $102.3 $33.0
        

Our weighted average interest rate for our five year $60.0 million Term Loan under our existing senior secured Credit Agreement was 3.4% for the three and nine-month periods ended September 30, 2014, as compared to 2.7% for the three and nine-month periods ended September 30, 2013.

 

On July 28, 2014, we entered into a Second Lien Credit Agreement providing for a term loan in an aggregate principal amount of $70.0 million. The proceeds of $67.4 million were used to pay off a portion of the revolving credit balances under our existing senior secured Credit Agreement dated as of October 26, 2012. Our weighted average interest rate for our Second Lien Loan was 8.5% for the three-month period ended September 30, 2014.

 

In connection with the Second Lien Credit Agreement, on July 28, 2014, we entered into the fourth amendment to our existing senior secured Credit Agreement, which amends certain covenants, representations and other provisions in our Credit Agreement, to among other things, allow for our entry into the Second Lien Credit Agreement. The fourth amendment also decreases the aggregate principal amount of the revolving credit facility under our existing senior secured Credit Agreement from up to $165.0 million to up to $120.0 million.

 

Our existing senior secured Credit Agreement, as amended on July 28, 2014, limits total leverage, senior secured leverage and requires minimum coverage of fixed charges. As of September 30, 2014, our total leverage ratio was 2.1, our senior secured leverage was 1.2 and our fixed charge coverage ratio was 1.8 and we are in compliance with the existing senior secured Credit Agreement. We currently anticipate we will be in compliance with the covenants associated with our long-term obligations over the next 12 months. In the event we are not in compliance with our debt covenants in the future, we would pursue various alternatives in an attempt to successfully resolve the non-compliance, which might include, among other things, seeking debt covenant waivers or amendments.

 

As of the date of this filing, our availability under our $120.0 million Revolving Credit Facility, as amended by the fourth amendment to our existing senior secured Credit Agreement, was $55.7 million and we had $19.3 million outstanding in letters of credit.

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Long Term Debt (Parenthetical) (Detail) (USD $)
In Millions, unless otherwise specified
9 Months Ended
Sep. 30, 2014
Jul. 28, 2014
Revolving Credit Facilities [Member]
   
Debt Instrument [Line Items]    
Principal amount $ 120.0 $ 120.0
Eurodollar Rate plus the applicable percentage 3.41%  
Maturity date Oct. 26, 2017  
Term Loan [Member]
   
Debt Instrument [Line Items]    
Principal amount 60.0  
Eurodollar Rate plus the applicable percentage 3.41%  
Maturity date Oct. 26, 2017  
Debt Instrument Periodic Payment Principal 3.0  
Second Lien Credit Agreement Term Loan [Member]
   
Debt Instrument [Line Items]    
Principal amount $ 70.0 $ 70.0
Eurodollar Rate plus the applicable percentage 8.50%  
Maturity date Jul. 28, 2020  
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Schedule of Financial Instruments Where Carrying Value and Fair Value Differ (Detail) (USD $)
In Millions, unless otherwise specified
Sep. 30, 2014
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]  
Long-term obligations, excluding capital leases $ 114.3
Fair Value, Inputs, Level 1 [Member]
 
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]  
Long-term obligations, excluding capital leases 0
Fair Value Inputs Level 2 [Member]
 
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]  
Long-term obligations, excluding capital leases 115.4
Fair Value, Inputs, Level 3 [Member]
 
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]  
Long-term obligations, excluding capital leases $ 0