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July 23, 2021

California-based Interface Rehab has agreed to pay $2 million to settle claims arising from a qui tam suit by its former director of rehab, Keith Pennetti.  According to Pennetti, Interface violated the False Claims Act when it pressured its therapists to increase the amount of therapy provided to Medicare Part A residents at eleven facilities, with no regard to medical necessity, and caused false claims to be submitted to Medicare.  For instigating the action, Pennetti will receive $360,000 of the settlement proceeds.  USAO CDCA

July 2, 2021

Select Medical Corporation (SMC) and Encore GC Acquisition LLL have agreed to pay $8.4 million to settle allegations that contract rehabilitation therapy provider Select Medical Rehabilitation Services Inc. (SMRS)—a previous subsidiary of SMC and current subsidiary of Encore—violated the False Claims Act.  According to former SMRS employee Melissa Vail, SMRS’s desire to maximize profits led it to provide medically unnecessary, unreasonable, and unskilled therapy services, and subsequently caused twelve skilled nursing facilities in the New York and New Jersey area to submit false claims to Medicare over a six-year period.  USAO NJ

A New Day for Data Whistleblowers: DOJ Joins First False Claims Act Case Brought by Data Analysis Firm Whistleblower

Posted  06/17/21
By Mary Inman, Max Voldman
nurse checking elderly woman
In a potential watershed moment, data whistleblowing pioneer Integra Med Analytics secured their first government intervention in a False Claims Act case alleging Medicare billing fraud against a group of skilled nursing facilities in New York. Integra's action alleges that over the course of almost a decade, the fraud resulted in overcharges exceeding $129 million.

Integra's Data Whistleblowing

Integra purports to...

May 21, 2021

SavaSeniorCare LLC and related entities (“Sava”) will pay $11.2 million, plus potentially more pursuant to an “ability-to-pay” settlement, to resolve allegations that Sava violated the False Claims Act by causing its skilled nursing facilities to bill Medicare for rehabilitation therapy services that were not reasonable, necessary, or skilled, and that Sava billed the Medicare and Medicaid programs for grossly substandard (i.e., “worthless”) skilled nursing services.  The settlement stems from four separate qui tam complaints filed by whistleblowers Rita Hayward, Trammel Kukoyi, Terrence Scott, James Thornton, and Barbara Roberts, who will share an undisclosed portion of the government’s recovery.  In 2015, the United States intervened in the litigation and filed a consolidated False Claims Act complaint, alleging inter alia that Sava had exerted significant pressure on its skilled nursing facilities to meet unrealistic corporate targets for the highest Medicare reimbursement rates without regard to patients’ actual clinical needs, and improperly delayed the discharge of patients from its facilities in order to increase billings.  Sava will enter into a five-year Corporate Integrity Agreement as part of the settlement.  DOJ

Private-Equity Red Flags Signal Potential False Claims Act Liability

Posted  05/21/21
By Jessica T. Moore
person following a trail of money
Private equity (PE) firms that manage healthcare entities have further reason to take note of the growing record of exposure for False Claims Act (FCA) liability.

Martino-Fleming Case

In the latest shot across the bow, the PE firm, a majority shareholder of a for-profit mental-health provider, knew about the false claims and played a sufficiently active role in operations potentially to have caused them. Evidence...

May 10, 2021

Iowa skilled nursing facility Dubuque Specialty Care, owned by Care Initiatives, will pay $214,200 to resolve claims that they received federal Medicaid funds during a COVID-19 outbreak at the facility while failing to adhere to requirements for infection control, including procedures for screening symptomatic employees for COVID-19.  USAO ND Iowa

Disturbing New Evidence Suggests Fraud Underlies Five-Star Ratings for Some Nursing Homes

Posted  03/19/21
By Jessica T. Moore
Nurse helping elder man walking in rehab facility
Twelve years after the implementation of the nursing-home star-ratings system, a disturbing New York Times exposé and a lawsuit by California against Brookdale Senior Living reveals how the ratings are manipulated to the detriment of families in their time of crisis.  The NYT’s investigation and California’s allegations in combination paint the troubling picture of profits tied to higher star ratings, and...

DOJ Previews False Claims Act Enforcement Priorities for 2021

Posted  03/5/21
Department of Justice Seal on the United States Flag
The False Claims Act is the federal government's primary enforcement tool to combat fraud against the public.  Every year the government recovers billions of dollars under the statute, primarily with the help of whistleblowers.  Under the so-called qui tam provisions of the act, whistleblowers are authorized to act as private attorneys general and bring lawsuits on behalf of the government and recover a portion of...

Constantine Cannon and AARP Foundation Represent Advocacy Groups on behalf of Nursing-Home Patients to Ensure Facility Accountability

Posted  01/22/21
nurse checking elderly woman
Constantine Cannon LLP proudly joins the AARP Foundation in representing the National Consumer Voice for Quality Long-Term Care and California Advocates for Nursing Home Reform in a lawsuit seeking to roll back a directive undercutting accountability for nursing homes that violate federal standards.  The federal Nursing Home Reform Act of 1987 allows states to recommend to CMS that a non-compliant facility pay civil...

January 11, 2021

California-based AutoGenomics, Inc. has agreed to pay over $2.5 million to settle allegations of submitting kickback-tainted claims to Medicare.  Between 2013 and 2015, AutoGenomics allegedly paid kickbacks to a healthcare marketing company for each genetic test performed by AutoGenomics’ former laboratory, PersonalizeDxLabs.  The kickbacks were only paid if the claims were reimbursed by Medicare.  Pursuant to the agreement, the company linked up with Prestige Administrative Services, LLC, which owns and operates residential nursing homes in multiple states, to identify and obtain samples from Prestige’s Medicare patients to send to PersonalizeDxLabs, in violation of the Anti-Kickback Statute and the False Claims Act.  USAO WDWI
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