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 […]

SEC Sues Investor at Center of Record Nursing Home Loan Default for Fraud

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 […]

Record-Setting $1.3B Nursing Home Fraud Case Ends in 20-Year Prison Sentence

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 […]

Feds Ask for $38M Judgment in Record-Setting Nursing Home Fraud Case

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 […]

Diversicare Reaches Tentative $9.5M Agreement to Settle DOJ Investigation

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 […]

Skilled Nursing Facilities, Therapy Provider to Pay $9.7M to Settle False Claims Act Allegations [Updated]

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 […]

HHS, DOJ Tout $2.3B in Fraud Recoveries — Including $47M from Skilled Nursing Facilities

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 […]

$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 […]