SNF
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August 10, 2022
American Senior Communities, L.L.C., will pay over $5.5 million for violating the False Claims Act by charging Medicare directly for hospice services that should have already been covered by the beneficiaries’ Medicare hospice coverage. The fraudulent billing practice was exposed in a whistleblower complaint filed by a former employee of a hospice services provider that worked with ASC. The whistleblower is entitled to receive between 15 and 25% of the recovery. USAO SDINJuly 29, 2022
Old Man’s Home of Philadelphia d/b/a Saunders House, a skilled nursing facility, will pay $819,640 for its violations of the False Claims Act. A whistleblower filed suit under the qui tam provisions of the FCA, alleging Saunders House overbilled federal healthcare programs for therapy services provided; billed for therapy services not provided; billed for unreasonable, unnecessary, and sometimes harmful therapy; and manipulated clinical services to maximize billing. Medicare Part A paid Saunders House based on beneficiaries’ assigned Resource Utilization Group, and Saunders billed at the highest RUG level—Ultra High or RU—despite the lack of reasonableness or necessity for the patients. USAO EDPAJune 29, 2022
Citadel Care Centers LLC and Plaza Rehab and Nursing Center will pay $7.85 million for switching their elderly residents’ Medicare coverage to maximize the Medicare payments the centers would receive--a blatant False Claims Act violation. Citadel directed Plaza employees to disenroll residents from Medicare Advantage Plans and enroll them in Original Medicare instead—without the residents’ knowledge or consent—to maximize their reimbursements. USAO SDNYMarch 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 DOJThree States Impose Profit Limits on Nursing Homes
Posted 10/29/21
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 GaJuly 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 CDCAJuly 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 NJA New Day for Data Whistleblowers: DOJ Joins First False Claims Act Case Brought by Data Analysis Firm Whistleblower
Posted 06/17/21
, Max Voldman
, Max Voldman
