Contact

Click here for a confidential contact or call:

1-212-350-2774

SNF

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

Page 1 of 10

February 27, 2023

Several individuals and entities involved with the Saratoga Center for Rehabilitation and Skilled Nursing Care have agreed to pay over $7.1 million to resolve allegations of violating the False Claims Act by submitting claims for essentially worthless services.  From 2017 until the center closed in 2021, while receiving reimbursements from New York’s Medicaid program, the center’s owners and operators failed to provide adequate staffing, hot water, and clean linens, and failed to dispose of solid waste.  As a result of these failures, conditions fell below regulatory standards, and residents suffered from unnecessary errors and neglect.  NY AG; DOJ

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 SDIN

July 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 EDPA

June 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 SDNY

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...
1 2 3 10