HHS, DOJ Tout $2.3B in Fraud Recoveries — Including $47M from Skilled Nursing Facilities

The federal government recovered $2.3 billion in allegedly fraudulent health care reimbursements in fiscal 2018, with several big-dollar skilled nursing settlements contributing to that total.

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) last week released a joint report on their health care fraud activities for the previous fiscal year, which concluded in the fall of 2018.

The two federal departments together operate the Health Care Fraud and Abuse Control Program, which seeks to coordinate law enforcement efforts across all levels to focus on improper Medicare and Medicaid billings.

That $2.3 billion haul included $1.2 billion in Medicare recoveries, along with $232 million in Medicaid money transferred back to the federal treasury.

“In its twenty-second year of operation, the program’s continued success confirms the soundness of a collaborative approach to identify and prosecute the most egregious instances of health care fraud, to prevent future fraud and abuse, and to protect program beneficiaries,” the agencies wrote in their report.

The joint program’s activities saw about $47 million in skilled nursing recoveries last fiscal year, driven primarily by a $30 million settlement with operator Signature HealthCARE over allegations of improper or unnecessary rehabilitation reimbursements.

Other highlights from the federal crackdown on nursing homes included a $6 million settlement with Catholic Health System Inc., which officials accused of providing false rehab claims at three of its facilities between 2007 and 2014. Similarly, the government collected $10 million from Southern SNF Management Services, Dynamic Rehab, and other related entities over improper therapy claims.

Outside of false therapy claims, the federal government highlighted a case in which a county hospital system billed non-emergency ambulance transfers to skilled nursing facilities at the higher emergency rate, as well as a SNF company that had employed workers deemed ineligible to provide federally reimbursed health care services.

Finally, the government applauded the efforts of the HHS Office of the General Counsel, noting its involvement in a high-profile case affecting more than 100 nursing homes — including 65 in receivership in Kansas, Nebraska, South Dakota, Arkansas, and Pennsylvania. While the HHS and DOJ did not name the chain, this appears to be a reference to Skyline Healthcare, a 100-building operator that saw economic turmoil and closures in those states over the course of 2017 and 2018.

“This required ensuring the proper flow of funds to the receivers to deliver care to the thousands of residents, including the use of federal CMP [civil monetary penalty] funds to help bridge funding gaps in some states,” the government wrote.