The Department of Justice this week announced the creation of a specialized task force targeting “grossly substandard care” in nursing homes, with both criminal and civil penalties on the table for owners and operators. About 30 individual facilities across nine states are already under investigation, the DOJ revealed in announcing its new National Nursing Home […]
Category: Fraud
Attend any conference geared toward long-term and post-acute health care operators, and you’ll hear a common thread: Data is king. In a landscape defined by value-based payment models such as Medicare Advantage plans and accountable care organizations (ACOs), investing in data analytics has become almost a prerequisite for success. If a given operator can prove […]
Guardian Elder Care, a nursing home operator with more than 50 buildings, will pay $15.5 million to resolve federal accusations of medically inappropriate therapy practices, the Department of Justice announced Wednesday. The Brockway, Pa.-based Guardian faced allegations — brought by a pair of former employees — that the company pressured therapists to perform unnecessary services […]
Greystone on Monday formally announced its takeover of 13 properties from the federal government, marking a new chapter for the much-publicized Rosewood Care Centers portfolio. The New York City-based investment firm installed an operational affiliate, Greystone Healthcare Management-Midwest, as the operator of the former Rosewood buildings in Illinois and Missouri, which include 12 skilled nursing […]
The operator of an ambulance company that primarily served nursing homes and other outpatient care sites has been sentenced to 30 months in federal prison after pleading guilty to defrauding Medicare and Medicaid. Joseph Valdie Kimble, the former operator of the Longview, Texas-based Tiger EMS, must also pay more than $750,000 in restitution to the […]
CVS Health (NYSE: CVS) CEO Larry Merlo this week described the health care giant’s experience with its Omnicare long-term pharmacy subsidiary, which serves nursing homes nationwide, as “disappointing.” Speaking Tuesday at the J.P. Morgan Healthcare Conference in San Francisco, Merlo made a small reference to frustrations over struggles in the long-term care space since CVS […]
The federal government on Tuesday announced a civil lawsuit against long-term care pharmacy heavyweight Omnicare, Inc. and its parent, CVS Health (NYSE: CVS), over allegations of widespread billing fraud. The Department of Health and Human Services (HHS), through its Office of the Inspector General (OIG) watchdog arm, accused Omnicare and CVS of illegally “rolling over” […]
The former nursing home owner behind the largest criminal health care fraud case in U.S. history had already received a 20-year prison sentence, but a federal judge on Thursday added a $44 million payment to the punishment. Philip Esformes, who once ran a skilled nursing facility and assisted living chain with locations from Miami to […]
In a twist on typical allegations of Medicaid overpayments, the state of Louisiana will be paying back millions to the federal government. The Louisiana Department of Health (DOH) agreed to pay $13.42 million to settle allegations that it submitted inflated claims for long-term nursing home and hospice care, the federal Department of Justice (DOJ) announced […]
When Lantis Enterprises, Inc., a South Dakota health care management firm, took over certain properties from the bankrupt Welcov Healthcare on September 1, 2018, the operators didn’t expect that a prior fraud claim — based on allegations of excessive and improper Medicare billing dating back to 2012 — would haunt their company name and potential […]
The Department of Justice will soon embark on a plan to pursue criminal charges in False Claims Act cases involving nursing homes, Bloomberg Law reported Monday, as the federal government attempts to crack down on bad actors in the space. “We need to go after cases civilly because they a [sic] providing grossly substandard care […]
A mobile diagnostics company this week reached an $8.5 million settlement with the federal government to resolve allegations that it engaged in a kickback scheme with some of its skilled nursing partners. The Department of Justice accused Trident USA Health Services LLC of orchestrating “swapping” arrangements with SNFs, offering its X-ray and other diagnostic services […]
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 […]
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 […]
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 […]
With less than a month to go before the implementation of the new Medicare payment system for nursing homes, most providers should have a firm plan in place to effectively capture reimbursements on October 1. But as the Patient-Driven Payment Model (PDPM) transitions from a proposal to a reality, operators need to prepare for the […]
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 […]
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 […]
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 […]
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 […]