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 […]
Category: Fraud
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
As the skilled nursing industry prepares for a shift away from therapy as a primary reimbursement driver, a new study raises questions about the use of high-intensity therapy minutes at the end of residents’ lives. Between 2012 and 2016, ultra-high rehabilitation services provided to nursing home residents in their final month of life spiked 65%, […]
A court last year threw out a case that accused a group of Pennsylvania nursing homes of false advertising, but the state’s highest court this week ruled that the legal action can proceed. Skilled nursing operator Golden Gate National Senior Care, LLC and its affiliates can indeed face legal trouble over advertisements that promised specific […]
An affiliate of skilled nursing provider Centers Health Care paid a $1.65 million settlement to the New York State and federal governments over allegations that its managed Medicaid plan falsely billed for services. The Centers Plan for Healthy Living LLC submitted monthly state Medicaid claims of up to $4,300 per member for services that it […]
In the wake of controversy over nationwide skilled nursing staffing levels, the health care industry’s top government watchdog has stepped in to investigate. The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) announced that it will launch a probe into the way skilled nursing facilities maintain their staffing records — […]
Reliant Rehabilitation Holdings Inc. agreed to pay the U.S. $6.1 million to resolve claims that it paid kickbacks to doctors and skilled nursing facilities to promote its rehabilitation therapy business, the Department of Justice announced Thursday. Between April 1, 2013 and May 1, 2017, the Plano, Texas-based rehabilitation therapy provider allegedly employed nurse practitioners at […]
The case against a former Miami-area skilled nursing operator accused of pulling off the largest Medicare fraud on record hit a snag this week as a judge tossed crucial pieces of evidence. Defense lawyers for Philip Esformes scored a major victory when a judge found that federal investigators improperly seized evidence that was protected under […]