Provider in $1.5M Skilled Nursing Settlement Responds to ‘Inaccurate’ Government Claims

Management at Conway Lakes Health & Rehabilitation in Orlando this week struck back at the federal government’s claims of malfeasance, days after regulators announced a $1.5 million settlement deal to resolve allegations of illegal kickbacks.

The Department of Justice accused Clear Choice Health Care, the operator of Conway Lakes, and its employees of giving improper payments to a doctor in exchange for Medicare referrals. The Melbourne, Fla.-based provider and three employees — including executives Geoffrey Fraser and Jeffrey Cleveland — earlier this month paid $1 million to settle the allegations without admitting fault, with the doctor responsible for the remaining $500,000. Under the False Claims Act, $267,000 of that money will go to whistleblower and former Conway Lakes employee Jonathan Montes de Oca.

But in a statement provided to Skilled Nursing News by Fraser, part-owner and senior vice president of Clear Choice, the company strongly denied the government’s version of events and classified recent news about the facility as “inaccurate.”

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“While Conway Lakes disputes the allegations made by Mr. Montes de Oca, it determined that it would be less disruptive to its business and its patients to negotiate a settlement with the government,” the company said.

Montes de Oca had been dismissed for failing to show up to work, according to the statement from Fraser, and the government’s investigation did not turn up evidence of improper payments, the company asserts.

Conway Lakes management also emphasized the work of its employees and noted that it maintains an “extensive compliance program” with an anonymous hotline that residents and workers can use to report any issues. The 120-bed facility currently has a five-star rating from the Centers for Medicare & Medicaid Services (CMS), which the government classifies as “much above average.”

“While we appreciate the government’s efforts to reduce waste in the Medicare system, the publishing of inaccurate information surrounding the whistleblower action takes away from the tremendous accomplishments of Conway Lakes’ employees,” the company said in the statement.

The Department of Justice emphasized in its original statement that the settlement simply resolves the complaint without any admission of guilt or acceptance of responsibility. These settlements are a common way that providers accused of False Claims Act violations remove themselves from government scrutiny: In fiscal 2018 alone, the Department of Justice collected more than $2.8 billion in FCA cases, with $2.5 billion of that figure coming from the health care industry. Federal officials claim a total haul of $59 billion since Congress passed the modern version of the law in 1986.

“The Department of Justice has placed a high priority on rooting out and pursuing those who cheat government programs for their own gain,” assistant attorney general Jody Hunt said in a December statement about the $2.8 billion gained in 2018. “The recoveries announced today are a message that fraud and dishonesty will not be tolerated.”

Several skilled nursing providers have seen significant FCA settlement burdens in recent years, with Signature HealthCARE shelling out $30 million to resolve claims of false rehabilitation therapy billing and Reliant Rehabilitation paying a $6.1 million settlement over kickback allegations in 2018. In both cases, as with Conway Lakes, the government noted that the payments did not amount to admissions of guilt or liability.

On the other side of the coin, Florida provider Salus Rehabilitation logged a major victory last year when a judge threw out a $350 million FCA penalty; HCR ManorCare similarly had a case dismissed back in 2017.

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