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This archive displays posts tagged as relevant to fraud involving skilled nursing facilities. You may also be interested in our pages:

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March 11, 2022

California state and local entities secured a $3.25 million settlement with Brookdale Senior Living, Inc. resolving allegations that the skilled nursing facility company misrepresented its services and quality of care, fraudulently inflating the star ratings for specific Brookdale facilities in California.  The government alleged that Brookdale failed to timely provide required notice to residents of transfers or discharges, and over-reported its nursing staffing hours to CMS.  CA DOJ

Three States Impose Profit Limits on Nursing Homes

Posted  10/29/21
By Leah Judge
Woman holding elderly person's wrist
New York, New Jersey, and Massachusetts have just sent a clear message to nursing home operators: patient care must be prioritized over profits.  Each state is introducing rules requiring nursing homes to spend a specific portion of their total revenue on direct patient care.  In New York, it will be at least 70%, in Massachusetts at least 75%, and in New Jersey at least 90%.  The three states are also limiting...

August 25, 2021

Georgia-based psychotherapy provide Carenow Services, LLC, together with its CEO Leena Karun, will pay $2 million to resolve allegations of FCA violations through their billing for services at nursing homes that were not medically necessary, that were improperly documented, and at higher intensity levels than justified.  The investigation was initiated when a former Carenow employee filed a qui tam complaint; the whistleblower will receive an undisclosed whistleblower reward.  USAO ND Ga

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
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
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...
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