Led by Biden’s HHS Pick, California Sues Brookdale Over Alleged Nursing Home Data Reporting Fraud

The state of California on Monday filed a lawsuit against Brookdale Senior Living (NYSE: BKD), accusing the company of submitting false nursing home staffing data to the federal government and improperly handling resident discharges. California attorney general Xavier Becerra — President Biden’s pick to serve as secretary of the Department of Health and Human Services […]

Federal Grand Jury Indicts Former Nursing Home Administrator Over Alleged Staffing Fraud

A federal grand jury in Pittsburgh indicted the former administrator of a skilled nursing facility in the region on charges of conspiracy to defraud the U.S., health care fraud, and the obstruction of a federal audit, U.S. attorney Scott W. Brady and Pennsylvania Attorney General Josh Shapiro announced Thursday. The three-count indictment names Susan Gilbert, […]

Nursing Home Management Firm CareOne Pays $700K to Settle False Claims Act Allegations

A management company that provided financial back-office services to health care facilities agreed to pay $714,996 to resolve allegations that it violated the False Claims Act — specifically related to claims for reimbursement of Medicare bad debt — acting U.S. attorney Rachael A. Honig announced this week. The federal government through the U.S. Department of […]

Trump Commutes Prison Sentence for Nursing Home Executive in Record-Breaking Fraud Case

As part of a slew of clemency grants announced by the White House on December 22, President Donald Trump commuted a 20-year prison sentence for Philip Esformes, who used to control a network of skilled nursing and assisted living facilities running from Miami to Chicago. The remaining parts of Esformes’ sentence, including supervised release and […]

Former Rosewood Owner Indicted on 10 Fraud Counts in Nursing Home ‘Ponzi Scheme’

The federal government this week announced a multiple-count indictment against a former Chicago-area nursing home owner, alleging that he and a top executive ran a “Ponzi scheme” that defrauded investors out of $22.8 million. Zvi Feiner, formerly the owner and CEO of the Skokie, Ill.-based FNR Healthcare LLC, stands accused of misleading investors about the […]

Longwood Management, Affiliates to Pay $16.7M in False Claims Act Settlement Over Rehab Services

Longwood Management Corporation, along with 27 individual affiliated skilled nursing facilities, will pay $16.7 million to settle federal allegations of rehabilitation billing fraud, the Department of Justice announced Monday. The government accused the Los Angeles-based firm of pressuring therapists to hit predetermined targets for rehab minutes under the Ultra High category, which provided the greatest […]

Judge Reinstates Part of Previously Tossed $348M FCA Verdict Against Nursing Home Manager [Updated]

The U.S. Court of Appeals for the Eleventh Circuit this week reinstated part of a False Claims Act (FCA) verdict that was overturned in 2018, issuing a judgment of more than $255 million against two skilled nursing facilities, two related entities providing management services at the facilities, and an affiliated company providing rehabilitation services. The […]

OIG Launches Multiple Investigations into Nursing Home Response to COVID-19

The Department of Health and Human Services’ (HHS) watchdog arm added multiple probes of nursing homes’ response to COVID-19 to its list of top 2020 priorities, with a particular focus on infection control. The HHS Office of the Inspector General (OIG) last Friday announced two coronavirus-related investigations as part of its ongoing 2020 Work Plan […]

DOJ Forms Nursing Home Task Force, Promises Criminal and Civil Penalties for Owners and Operators

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 […]

Rise of Data Could Bring More False Claims Act Cases, CMS Scrutiny to Skilled Nursing

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 […]

Nursing Home Operator Guardian Elder Care to Pay $15.5M in False Claims Act Settlement

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 Confirms Takeover of 13-Property Rosewood Skilled Nursing Portfolio from HUD

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 […]

Ambulance Company Operator Given Prison Time, $750K Fine in Skilled Nursing Fraud Case

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 CEO: Omnicare Long-Term Care Pharmacy Business ‘Disappointing’

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 […]

Feds Sue CVS, Omnicare Over Allegations of Fraudulent Long-Term Care Pharmacy Billing

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” […]

Record-Setting Nursing Home Fraud Case Ends in $44M Judgment

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 […]

Louisiana to Pay $13.4M to Settle Allegations of Inflated Medicaid Claims for Nursing Home Care

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 […]

Skilled Nursing Provider Haunted by Problems of the Past When Taking Over from Troubled Tenants

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 […]

DOJ to Pursue Criminal Charges in False Claims Act Cases Against Nursing Homes

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 […]

X-Ray Vendor Reaches $8.5M Settlement to Resolve Skilled Nursing Kickback Allegations

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 […]