Top Trends in False Claims Act Litigation Against Nursing Home Operators

While nursing home operators are dealing with a host of financial and operational challenges, they must as always be alert to how the Department of Justice (DOJ) is pursuing False Claims Act cases against providers. Nursing home practices under Covid-era waivers, the transition to the Patient-Driven Payment Model (PDPM), and concerns over substandard care are […]

Grassley Presses for Answers From CMS, DOJ on Troubled NJ Nursing Home

A Republican senator is calling on the Justice Department to open an investigation into the “egregious and flagrant conditions” at the Woodland Behavioral and Nursing Center, a nursing home that has made national headlines amid the COVID-19 pandemic. U.S. Sen. Chuck Grassley of Iowa penned a letter to Attorney General Merrick Garland on Wednesday, urging […]

Interface Rehab to Pay $2M in False Claims Act Settlement

Interface Rehab will pay $2 million to settle federal allegations of rehabilitation billing fraud, the Department of Justice announced on Friday. This announcement comes one year after the DOJ announced a $16.7 million False Claims Act settlement with Longwood Management Corporation and 27 individual affiliated skilled nursing facilities over its rehabilitation services. The $2 million […]

SavaSeniorCare to Pay $11.2M to Settle False Claims Allegations

The nursing home operator SavaSeniorCare LLC and its related entities have agreed to pay $11.2 million to resolve allegations it violated the False Claims Act (FCA), the Department of Justice (DOJ) announced Friday. That amount encompasses both federal and state settlements, with additional payments possible “if certain financial contingencies occur,” according to the DOJ. The […]

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 […]

DOJ Demands Information on Nursing Home COVID Orders from Governors, Mulls Investigation

The Department of Justice on Wednesday sent letters to four state governors requesting detailed information about their decisions regarding COVID-19 in nursing homes, potentially setting the stage for a formal civil rights investigation. The federal agency’s Civil Rights Division in particular wants data regarding the controversial decisions — made in New York, New Jersey, Pennsylvania, […]

DOJ Rarely Used Nursing Home Data to Pursue Abuse Claims. COVID-19 Could Change That

When the COVID-19 pandemic started gathering momentum in spring, several states took steps to shield health care providers, including skilled nursing facilities, from liability related to care provided during the national emergency. But the rules varied widely from state to state, and other issues might be looming beyond the realm of lawsuits. The Department of […]

Encore Rehabilitation, DOJ Reach $4M Settlement in False Claims Act Case

Encore Rehabilitation Services on Friday publicly agreed to pay $4 million to settle federal allegations that the contract rehab provider violated the False Claims Act. The Department of Justice had accused the Farmington Hills, Mich.-based rehab operator of “causing three Michigan skilled nursing facilities to submit false claims to Medicare for rehabilitation therapy services that […]

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 […]

Diversicare Formally Ends Eight-Year DOJ Investigation with $9.5 Million Settlement Deal

Diversicare Healthcare Services (OTC: DVCR) on Wednesday announced that it has formally closed the book on a Department of Justice investigation that has stretched for nearly eight years. The Brentwood, Tenn.-based skilled nursing provider will pay out the $9.5 million throughout the next five years to resolve a False Claims Act case regarding its therapy […]

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 […]

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 […]

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 […]

Skilled Nursing Must-Reads: A Nursing Home for Parolees

Start your week with a look at some of the most interesting skilled nursing stories from around the web, including a SNF with a unique clientele in Connecticut. SNF that serves parolees wins case A skilled nursing facility that serves prison parolees in the suburbs of Hartford, Conn. won a court ruling this week against […]

Feds Decide to Sit Out Fraud Case Against ManorCare Hospice Arm

The U.S. government declined to intervene in a False Claims Act (FCA) case brought against HCR ManorCare’s hospice division, though it asked to be kept updated on pleadings in the case. The decision to not intervene marks another victory in FCA cases for ManorCare; in November, a Medicare fraud case against the Toledo, Ohio-based skilled nursing […]