SKILLED NURSING FACILITIES (SNF) AND NURSING HOMES
DA TE
ENTITY
FCA ALLEGATIONS
AMOUNT
SNF operator and an affiliated center agreed to pay more than $121,000 to resolve self- disclosed CMPL allegations that they employed an individual that they knew or should have known was excluded from participating in the California Medicaid program and that no Medi-Cal payments could be made for items or services the individual furnished. 28 SNF operator agreed to pay $214,200 to resolve allegations that the United States was entitled to restitution for the federal share of Medicaid funds that an affiliated facility received for a 10 week period that residents were suffering from or testing positive for COVID-19. The United States alleged that repayment of these funds was warranted due to the facility’s practices surrounding COVID-19 infections, including the facility’s procedures and criteria for screening symptomatic employees. 29 SNF operator agreed to pay $11.2 million to resolve FCA allegations that its corporate-wide policies and practices caused facilities to submit claims for medically unreasonable, unnecessary or unskilled rehabilitation therapy services. As part of the resolution, the company entered into a chain-wide five-year CIA with HHS-OIG. 30 SNF and its parent company agreed to pay more than $450,000 to resolve FCA allegations that an employee falsified and submitted claims to Medicare for services not provided. The government further alleged that when the SNF’s management became aware of the issue, it did not conduct an adequate investigation or submit a refund for the full amount management knew had been overbilled, or otherwise disclose the misconduct to the government. 31 Former parent company of a SNF chain and its successor-in-interest agreed to pay $8.4 million to resolve FCA allegations that the chain’s corporate policies and practices resulted in the submission of false claims to Medicare for rehabilitation therapy services that were not medically necessary, reasonable or skilled. 32 SNF agreed to pay $360,000 to resolve FCA allegations that it: (1) upcoded patients’ Resource Utilization Group (RUG) scores to receive higher Medicare reimbursement; (2) billed for therapy services provided to patients who did not need or could not benefit from such services; and (3) billed for services not provided or that were provided without a physician order. 33
Longwood Management Corp.; Intercommunity Healthcare and Rehabilitation Center
4/1/2021
$121,783
Care Initiatives
$214,200
5/10/2021
SavaSeniorCare LLC
$11.2 million
5/21/2021
Plum Healthcare Group, LLC; Azalea Holdings LLC d/b/a McKinley Park Care Center
6/29/2021
$451,439
Select Medical Corporation; Encore GC Acquisition LLC
7/2/2021
$8.4 million
Norridge Gardens
$360,000
8/16/2021
28 https://oig.hhs.gov/fraud/enforcement/longwood-management-corp-and-intercommunity-healthcare-and-rehabilitation-center-agreed-to-pay-121000-for-allegedly-violating-the-civil-monetary-penalties-law-by-employing-an- excluded-individual/. 29 https://www.justice.gov/usao-ndia/pr/dubuque-care-facility-s-owner-agrees-repay-federal-medicaid-funds-resolve-allegations. 30 https://www.justice.gov/usao-mdtn/pr/savaseniorcare-llc-agrees-pay-112-million-resolve-false-claims-act-allegations. 31 https://www.justice.gov/usao-edca/pr/california-s-second-largest-skilled-nursing-facility-operator-pays-450000-resolve-false. 32 https://www.justice.gov/opa/pr/contract-rehabilitation-therapy-providers-agree-pay-84-million-resolve-false-claims-act. 33 https://www.justice.gov/usao-ndil/pr/suburban-chicago-nursing-facility-pay-360000-resolve-false-claims-act-allegations.
NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 50
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