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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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September 7, 2016

Clinical psychologists Beverly Stubblefield and John Teal pleaded guilty for their involvement in a fraudulent psychological testing scheme that preyed upon Medicare recipients living in nursing homes throughout the Southeastern United States.  Stubblefield and Teal practiced as clinical psychologists at Nursing Home Psychological Services, Inc. and Psychological Care Services, Inc. and they admitted their companies billed Medicare for psychological tests to nursing home residents throughout Mississippi, Louisiana, Florida and Alabama which were not medically necessary or not provided at all.  They further admitted they repeatedly tested the same nursing home residents even though some were incapacitated and could not meaningfully participate in testing.  DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud, SNF,

June 22, 2016

New York announced a $28 million settlement of a civil lawsuit that claimed the owners of Medford Multicare Center for Living, Inc. (“Medford”) located in Medford, New York looted the corporation and committed fraud and illegality in operating a business. The civil lawsuits claims were based on a history of criminal conduct by employees of the nursing home, staffing and service cuts and diversion of Medicaid funds to themselves and their controlled entities. The assurance of discontinuance provides that the settlement funds, which will be administered by an Independent Financial Monitor, will in part be used to establish a “Resident Care Fund” to fund care recommendations by the Independent Operator. That fund will provide the much needed reforms and improvements in the delivery of care and services to Medford’s elderly and frail residents. In addition, ten million dollars will be returned to the Medicaid program. The Medford corporation was also sentenced for its role in the cover-up of a patient death in 2012.‎ NY

Tagged in: Healthcare Fraud, Medicaid, SNF,

January 12, 2016

Kentucky-based healthcare provider Kindred Healthcare, Inc. and its two RehabCare Group subsidiaries agreed to pay $125 million to resolve allegations of violating the False Claims Act by knowingly causing skilled nursing facilities to submit false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary and skilled, or that never occurred at all.  According to the government, RehabCare’s policy has been to achieve the highest Medicare reimbursement level regardless of the clinical needs of its patients, resulting in the provision of unreasonable and unnecessary services to Medicare patients, and its skilled nursing facility customers submitting inflated bills to Medicare covering those services.  The allegations originated in a whistleblower lawsuit filed by Janet Halpin, a RehabCare physical therapist and former rehabilitation manager, and Shawn Fahey, a RehabCare occupational therapist, under the qui tamprovisions of the False Claims Act.  They will receive a whistleblower award of nearly $24 million from the government proceeds of the settlement.  Whistleblower Insider

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, SNF, Whistleblower Case, Whistleblower Rewards,

December 23, 2015

Pennsylvania-based Genesis HealthCare LLC agreed to pay $600,000 to resolve charges it violated the False Claims Act in connection with its operation of a skilled nursing facility known as the Potomac Center.  Specifically, the government alleged that employees of Potomac/Genesis failed to provide patient care activities as recorded in the resident medical record of a patient and failed to provide certain care activities consistent with standing physician orders. DOJ (EDVA)

Tagged in: FCA Federal, Medical Billing Fraud, SNF,

December 23, 2015

A $2.5 million settlement with long term care pharmacy Pharmerica, which services hundreds of nursing homes across the nation, completes the final leg of litigation involving the illegal promotion of Aranesp, an anemia drug manufactured by Amgen, Inc.  Including the 2013 settlement with Amgen ($24.9 million) and the 2014 settlement with Omnicare ($4.19 million), this settlement brings the government’s total recovery in this matter to just over $31.5 million.  The allegations were originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (DSC)

Tagged in: Pharma Fraud, SNF, Whistleblower Case,

October 7, 2015

Kentucky-based nursing home pharmacy PharMerica Corp. agreed to pay $9.25 million to resolve allegations it violated the False Claims Act by soliciting and receiving kickbacks from pharmaceutical manufacturer Abbott Laboratories in exchange for promoting the anti-epileptic prescription drug Depakote for nursing home patients.  The settlement is part of the continuing fallout of the $1.5 billion settlement Abbott entered into with the government in May 2012 to resolve Abbott’s liability under the False Claims Act for alleged kickbacks to nursing home pharmacies, including PharMerica.  The settlement partially resolves allegations raised in two whistleblower lawsuits brought by former Abbott employees Richard Spetter and Meredith McCoyd under the qui tam provisions of the False Claims Act.  Ms. McCoyd will receive a whistleblower award of $1 million from the federal share of the settlement amount. Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, Multiple Whistleblowers and First-to-File, Off-Label and Unapproved Use, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

June 18, 2015

Edward Berman, a physician with a practice in Ridgefield, Connecticut, agreed to pay $218,633 to resolve allegations he violated the False Claims Act by submitting claims to Medicare for skilled nursing facility services that were not performed in accordance with Medicare requirements.  Specifically, the government alleges that Berman “upcoded” certain services, submitting claims to Medicare by using a higher-paying billing code when services with lower-paying billing codes were actually provided.  DOJ

Tagged in: FCA Federal, Medical Billing Fraud, SNF, Upcoding,

June 16, 2015

Hebrew Homes Health Network Inc., a Florida-based operator of rehabilitation and skilled nursing facilities, along with its former president and executive director William Zubkoff, agreed to pay $17 million to resolve allegations it violated the False Claims Act by improperly paying doctors for referrals of Medicare patients requiring skilled nursing care.  It is the largest settlement involving alleged violations of the Anti-Kickback Statute by skilled nursing facilities in the US.  The allegations against Hebrew Homes first arose in a whistleblower lawsuit filed by Stephen Beaujon, a former CFO of Hebrew Homes, under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $4.25 million.  Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, SNF, Whistleblower Case, Whistleblower Rewards,

May 14, 2015

PharMerica Corporation, an organization of long-term care pharmacies that dispense medications to residents of nursing homes and skilled nursing facilities across the country, agreed to pay $31.5 million to settle charges it violated the Controlled Substances Act by dispensing Schedule II controlled drugs without a valid prescription and violated the False Claims Act by submitting false claims to Medicare for these improperly dispensed drugs.  The government’s allegations against PharMerica arose out of whistleblower lawsuit brought by Jennifer Denk, a pharmacist formerly employed by PharMerica, under the qui tam provisions of the False Claims Act.  Ms. Denk will receive a whistleblower award of $4.3 million.  Whistleblower Insider

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

October 10, 2014

Extendicare Health Services Inc., an operator of a chain of skilled nursing facilities, and its subsidiary Progressive Step Corporation (ProStep), agreed to pay $38 million that Extendicare billed Medicare and Medicaid for materially substandard nursing services that were so deficient they were effectively worthless and billed Medicare for medically unreasonable and unnecessary rehabilitation therapy services. It is the largest failure of care settlement with a chain-wide skilled nursing facility in the Justice Department’s history. The government’s charges originated from two whistleblower lawsuits filed by Tracy Lovvron and Donald Gallick under the qui tam provisions of the False Claim Act. They will receive whistleblower awards of more than $1.8 million and $250,000, respectively. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, SNF, Whistleblower Case, Whistleblower Rewards,

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