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 […]

False Advertising Case Against Nursing Homes Gains New Life

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 […]

Centers Pays $1.6M Over Alleged Managed Medicaid Fraud in New York

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 […]

OIG to Investigate CMS Oversight of Skilled Nursing Staffing Measures

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 to Pay $6.1M to Settle FCA Claims of Kickbacks to Nursing Homes

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 […]

Record-Setting $1 Billion Skilled Nursing Fraud Case Hits Snag

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 […]

Signature HealthCARE to Pay $30M to Resolve FCA Claims Related to Rehab

Signature HealthCARE will pay more than $30 million to resolve allegations that it violated the False Claims Act (FCA) by knowingly submitting false claims to Medicare for rehabilitation therapy services. The settlement resolves allegations leveled in a lawsuit by Kristi Emerson and LeeAnn Tuesca, former Signature therapy employees, filed in federal court in Nashville, Tenn., and […]

Federal Judge Tosses $350M False Claims Act Penalty Against Provider

A federal judge last week threw out a $350 million False Claims Act judgment against a Florida nursing home provider, writing that its occasionally inaccurate record-keeping didn’t amount to deliberate fraud. In a fiery ruling, U.S. District Judge Steven D. Merryday wrote that the claims brought by a whistleblower against Salus Rehabilitation, LLC — namely […]

Social Security Program Could Help SNF Residents Manage Own Finances

A seldom-used Social Security program could help more people with Alzheimer’s or other forms of dementia manage their money, according to a new research brief from Boston College’s Center for Retirement Research. The Representative Payee Program lets a designated proxy receive and manage a retiree’s benefit check for them. Without some form of money management, seniors with dementia are […]

Public Outcry Over Skilled Nursing Arbitration Rule Grows

The skilled nursing industry cheered earlier this year when the Centers for Medicare & Medicaid Services (CMS) announced that it would reverse course on a plan to ban arbitration agreements between SNF operators and residents. But as the public learns more about the issue, the backlash has been harsh — and national publications are taking […]

‘Peggy’ Holds NJ Skilled Nursing Providers to Stronger Standard

The state of New Jersey took an added step to regulate elder care provided in institutional settings, recently implementing a new law that holds care providers to stricter reporting guidelines. Sponsored by Republican State Sen. James Holzapfel, “Peggy’s Law” requires any caretaker, social worker, physician, registered or licensed practical nurse, or other professional to immediately report suspected […]

Why Dark Skilled Nursing History Could Repeat Itself

Various health care agencies and groups have expressed concerns over the effects of Obamacare repeal on Americans’ access to skilled nursing care, as well as the ongoing viability of SNFs as a business amid steep Medicaid cuts. At least one commentator also claims that the GOP health plans could lead to a return to the […]

U.S. Skilled Nursing Investor Group Sues Alleged Canadian Fraudsters

A recently filed lawsuit alleges that U.S. investors moving to acquire 14 skilled nursing facilities and other senior housing properties actually were tricked by Canadian fraudsters. Illinois-based developer SSU LLC, which does business as Sunny Side Up, filed a lawsuit for $36 million in damages against Ontario-based Paramount Equity Financial Corporation, Canadian businessman Enzo Mizzi, […]

Genesis Finalizes $53.6 Million Settlement Deal with DOJ

Genesis HealthCare (NYSE: GEN) on Friday announced the execution of a $53.6 million settlement with the United States Department of Justice over a variety of improper billing allegations. The Kennett Square, Pa.-based post-acute provider denied all of the government’s claims, which included four separate sets of allegations involving various Genesis subsidiaries. In its complaint, the DOJ […]

NPR: State Regulators Cracking Down on Involuntary SNF Discharges

The Administration for Community Living logged more than 9,000 complaints about involuntary discharges from long-term care facility residents across the country in 2015, and now lawmakers are taking notice. In particular, officials in Maryland and Illinois have begun investigating discharge rates in their states, according to a recent report from NPR. Maryland Attorney General Brian […]