$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

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 million to settle federal allegations of an illegal kickback scheme. Federal prosecutors accused the Melbourne, Fla.-based Clear Choice Health Care, operator of the Conway Lakes Health & Rehabilitation facility, of paying doctor […]

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 […]

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 […]