SEC Sues Investor at Center of Record Nursing Home Loan Default for Fraud

The Securities and Exchange Commission (SEC) this week filed a lawsuit against the Chicago-area businessman at the center of a record-setting nursing home loan default, accusing the man and his company of defrauding investors and misappropriating funds. The SEC alleged that Zvi Feiner, a nursing home owner and Orthodox rabbi, raised money from various investors […]

Record-Setting $1.3B Nursing Home Fraud Case Ends in 20-Year Prison Sentence

Philip Esformes, who used to control a network of skilled nursing and assisted living facilities running from Miami to Chicago, was sentenced to 20 years in prison on Thursday. The legal publication Law360 first reported the news. The U.S. Justice Department called the case, which resulted in 20 guilty verdicts in April, the largest single […]

Feds Ask for $38M Judgment in Record-Setting Nursing Home Fraud Case

When the man at the center of a record-setting nursing home fraud case faces a sentencing hearing this week, he’ll also be staring down a nearly $39 million recovery judgment. The federal government has asked a judge to approve a plan that would force Philip Esformes, convicted earlier this year on 20 fraud-related counts, to […]

Diversicare Reaches Tentative $9.5M Agreement to Settle DOJ Investigation

Diversicare Healthcare Services (Nasdaq: DVCR) on Monday announced that it has reached a tentative agreement to settle an investigation into its therapy practices and other issues that had long served as a drag on its operations. “For six years, we’ve had this open investigation, but we’re now closer to having certainty on the matter,” CEO […]

Skilled Nursing Facilities, Therapy Provider to Pay $9.7M to Settle False Claims Act Allegations [Updated]

Physical therapy provider Quality Therapy & Consultation and four skilled nursing facilities — all in the Chicago metropolitan area — agreed to pay $9.7 million to resolve allegations of False Claims Act violations, the U.S. Attorney’s Office for the Northern District of Illinois announced Tuesday. The settlement and consent judgments resolve allegations that Quality Therapy […]

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 […]

$1 Billion Skilled Nursing Fraud Case Ends in 20 Guilty Verdicts

A nearly two-year-long case involving close to $1 billion in fraudulent Medicare and Medicaid billings came to a close this week with a slew of guilty verdicts in a Miami courtroom. A 12-person jury found former skilled nursing and assisted living executive Philip Esformes guilty of 20 charges, the Miami Herald and other sources reported […]

OIG Takes Back $48M in Fraudulent Medicaid Payments as Nursing Homes Lead List of Open Cases

Despite the second straight year of declines in overall recoveries, the Department of Health and Human Services’ (HHS) top watchdog arm took back nearly $50 million in Medicaid reimbursements from nursing homes in fiscal 2018. The HHS Office of the Inspector General (OIG) this week reported a haul of $48.7 million from nursing providers accused […]

Ensign Group Completes Five-Year OIG Oversight Agreement

Leading skilled nursing provider The Ensign Group (Nasdaq: ENSG) on Thursday announced that it has successfully completed a five-year Department of Health and Human Services (HHS) oversight period. The Mission Viejo, Calif.-based company initially entered into a corporate integrity agreement (CIA) with the HHS Office of the Inspector General (OIG) back in October 2013; at […]

Vanguard Healthcare Settles Medicare, Medicaid Fraud Claims for $18 Million

A Tennessee-based skilled nursing provider this week agreed to pay the federal government $18 million in order to resolve claims of Medicare and Medicaid fraud. Vanguard Healthcare, LLC of Brentwood, Tenn. — along with several of its affiliated firms — reached the deal with the Department of Justice, which accused the provider of providing “grossly […]

Skilled Nursing Staffing Firm Faces Fraud Investigation, Medicare Freeze

A nursing home staffing firm based in Nashville, Tenn., is facing an ongoing investigation into whether or not it overcharged the federal government — a process that has resulted in frozen Medicare reimbursements and missed checks for employees. The Tennessean first reported the news. Wellness Solutions Geriatrics (WSG) uses a network of nurse practitioners to […]

Skilled Nursing Management Company Settles FCA Claims for Nearly $10M

Tennessee Health Management, Inc., which operates 27 skilled nursing facilities in the Volunteer State, agreed to pay $9.76 million to settle allegations that it violated the False Claims Act. The agreement was announced by U.S. Attorney Don Cochran for the Middle District of Tennessee. “Enforcement of the False Claims Act remains a priority of the […]

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 […]

Orlando Skilled Nursing Facility, Executives to Pay $1.5M to Resolve Federal Kickback Allegations

Editor’s Note: After the publication of this article, Clear Choice Health Care responded to the allegations in a separate statement provided to Skilled Nursing News, strongly denying the government’s version of events. The operator of an Orlando skilled nursing facility, along with several executives and a third-party doctor, earlier this month agreed to pay $1.5 […]

PDPM Creates New Litigation Risk for Skilled Nursing, Rehab Providers

After years of facing governmental and legal scrutiny over providing too many rehabilitation hours, both skilled nursing and therapy providers will soon find themselves with the completely opposite risk. As the Patient-Driven Payment Model (PDPM) shifts incentives away from the volume of therapy hours, providers could find themselves accused of not providing enough rehabilitation time […]

Focus on PDPM Could Distract Skilled Nursing Operators from Current Risks

With a new payment model just eight months away, the skilled nursing industry has trained a laser-guided focus on maximizing patient outcomes and reimbursements under the system. But smart providers would be wise not to let the Patient-Driven Payment Model (PDPM) distract them from the pressing issues facing them between now and October 1. “Any […]

OIG Touts Nearly $3B in Medicare, Medicaid Fraud Recoveries in Fiscal 2018

The Department of Health and Human Services’ top fraud watchdog recovered nearly $3 billion from providers in fiscal 2018, a figure that included more than $18 million in improper payments at nursing homes. The HHS Office of the Inspector General (OIG) touted its $2.91 billion haul in its most recent semiannual report to Congress, released […]

Maryland Provider Reaches $2M Settlement Over False Discharge Claims

An extended battle between a now-defunct nursing home operator and the state of Maryland reached a conclusion this week with a $2.2 million settlement. Neiswanger Management Services (NMS) agreed to pay that amount to dismiss allegations that it had improperly discharged Medicare residents and falsely billed the state’s Medicaid program, Maryland Medical Assistance. Back in […]