The Department of Justice has announced that the Ensign Group, Inc. (Ensign), which operates skilled nursing facilities (SNFs) across the western United States, has agreed to pay $48 million to resolve allegations that the company systematically defrauded the Medicare program by submitting bills for unnecessary therapy services.
Under the Medicare skilled nursing benefit, Medicare patients who experience a qualifying hospital stay (of three days or more) are eligible to receive up to 100 days of skilled nursing care, including rehabilitative therapy. SNFs bill the Medicare program for providing this care. In this case, however, the DoJ alleged that Ensign fraudulently billed the Untied States for therapy that was not medically necessary or was provided to patients who did not properly qualify for the SNF benefit. Fraudblawg and Frohsin & Barger have reported previously on the prevalence of SNF fraud in the Medicare system.
Two whistleblowers who filed qui tam False Claims Act cases against Ensign will receive awards as part of the settlement, in an amount yet to be determined.
Frohsin & Barger represent whistleblowers in FCA cases across the nation and have successfully prosecuted skilled nursing fraud cases. To report skilled nursing or SNF fraud and learn your rights under the False Claims Act, contact Frohsin & Barger.
Thanks to a false claims act case filed by former employee, Douglas Stone, Hospice of the Comforter, Inc. (HOTCI), an Orlando-area hospice company, has agreed to pay $3 million to the United States to settle allegations of hospice fraud. According to a DoJ press release, Mr. Stone filed the case in 2011, alleging that HOTCI directed its staff to admit all referred patients regardless of whether they were eligible for the Medicare hospice benefit, falsified medical records to make ineligible patients appear eligible, employed field nurses without hospice training, established procedures to limit physicians’ roles in assessing patients’ terminal status and delayed discharging patients when they became ineligible for the benefit.
As part of the settlement, HOTCI has entered into a Corporate Integrity Agreement with the Inspector General of the Department of Health and Human Services to prevent future misconduct. In addition, HOTCI’s CEO has agreed to a three-year, voluntary exclusion from all federal health care programs, including Medicare and Medicaid.
“Hospice care is a sacred trust from which no provider should fraudulently profit,” said Inspector General of the U.S. Department of Health and Human Services Daniel R. Levinson. “Claiming tax dollars for people who are not terminally ill, and therefore ineligible for hospice care, cannot be tolerated.”
Amedisys, Inc announced its third quarter earnings on November 12, 2013, which included a net income loss. The company said the loss was primarily attributable to a $150 million reserve established as part of a “tentative” settlement with the Department of Justice:
During the third quarter of 2013, we recorded an accrual of $150 million related to the tentative settlement of both the U.S. Department of Justice investigation and the Stark Law Self-Referral matter (the “U.S. Department of Justice settlement”). We have agreed to this tentative settlement without any admission of wrongdoing in order to resolve these matters and to avoid the uncertainty and expense of protracted litigation. In connection with the tentative settlement, we expect to enter into a corporate integrity agreement with the Office of the Inspector General. – HHS
As Fraudblawg previously reported, the Wall Street Journal ran an article in April, 2010, publishing the results of a study conducted by Yale University professor Henry Dove that strongly suggested that Amedisys and other major home health care companies like Gentiva, LHC Group, and Almost Family were “taking advantage” of the Medicare billing system.
Following the WSJ Article, the Senate Finance Committee mounted an investigation into Amedisys’ Medicare billing practices. As we reported, the Committee later issued a report concluding that the companies had “gamed” the Medicare program.
It now appears that the Department of Justice accepted the Senate Finance Committee’s charge to investigate the situation and is close to reaching a resolution where Amedisys is concerned.
After a three-day trial in Houston, Texas, a federal jury convicted Gwendolyn Climmons-Johnson of one count of conspiracy to commit health care fraud and four counts of health care fraud. According to a DOJ press release, Climmons-Johnson was the owner and operator of Urgent Response EMS, which provided non-emergency ambulance services to Medicare beneficiaries in the Houston area. From January 2010 until December 2011, Climmons-Johnson and her co-conspirators submitted false and fraudulent claims for approximately $2.4 million to Medicare for ambulance services that were not medically necessary and/or not provided. The evidence presented at trial showed that patient records had been falsified in that many Medicare beneficiaries that Climmons-Johnson had billed Medicare for did not need ambulance services and were not in the condition stated in the records. Climmons-Johnson faces a maximum penalty of 10 years in prison for each count when she is sentenced on February 7, 2014.
To report Medicare fraud, please contact Frohsin & Barger, LLC.
U.S. Attorney George Beck announced today a lawsuit against United States Investigations Services LLC (USIS) in the U.S. District Court for the Middle District of Alabama, alleging false claims for background checks for the United States Office of PRofessional Management (OPM). According to a DoJ press release, USIS “used a proprietary computer software program to automatically release to OPM background investigations that had not gone through the full review process and thus were not complete,” and thereafter “dump[ed]” the cases to fraudulently inflate its billing to OPM. According to an article in the Washington Post, USIS is the firm that OPM paid to vet the government’s employment of Edward Snowden, who has since been both glorified and vilified for leaking United Stats secrets and who currently lives in exile in Russia.
“Thorough, appropriate and accurate background checks are essential in the employment of government personnel,” said U.S. Attorney Beck Jr. “The increase in foreign and domestic terrorism places an increased responsibility on our government to ensure that unsuitable individuals are prohibited from government employment.”
Since his appointment as U.S. Attorney, George Beck, has shown a keen interest in protecting taxpayer dollars through enforcement of the federal False Claims Act. Earlier this year, Beck announced his office’s first intervention in a qui tam whistleblower suit against home health provider Cahaba Valley Home Health and Techota, LLC. In his press release, Beck praised whistleblowers and their attorneys for bringing such allegations to light, saying:
“Our office is grateful to the law firm of Frohsin and Barger who represented Ms. McDonald and brought this injustice to our attention,” stated U.S. Attorney Beck. “Our country needs those with knowledge about the fraud and false claims to realize that if they bring these injustices to our attention, we will diligently work to cure the injustice.”
Former employees and other corporate whistleblowers not only provide a great service to their country but also they can reap substantial awards of between 15% and in some instances up to 30% of the total recovery, depending on the facts and circumstances of the case.
To report False Claims Act violations, contact Frohisn & Barger.
Javed Rehman, a Detroit-area resident, pleaded guilty to one count of conspiracy to commit health care fraud in the Eastern District of Michigan according to a DOJ press release. In May 2009, Rehman and his co-conspirators, Tausif Rahman and Muhammed Ahmad, purchased Quantum Home Care, Inc. Rehman obtained Medicare beneficiary information by paying illegal kickbacks to recruiters and used the information to bill Medicare for physical therapy and skilled nursing services that were never rendered. From June 2009 until September 2011, Medicare paid Quantum approximately $1.7 million for home health services. Over the course of the conspiracy, Rahman and Ahmad gained control of three other home health care companies. Collectively, the four companies received approximately $13.8 million from Medicare.
Rahman pleaded guilty to one count of conspiracy to commit health care fraud and one count of money laundering on January 5, 2012. Ahmad pleaded guilty to one count of conspiracy to commit health care fraud on August 28, 2012. Both are scheduled for sentencing later this month. Rehman is scheduled for sentencing on November 7, 2013.
To report Medicare fraud, please contact Frohsin & Barger, LLC.
A federal indictment in the Northern District of Mississippi alleges that Angelic Hospice in Greenwood and its owner Regina Swims-King bilked the Medicare system for more than $11 million between 2007 and 2012, billing for services of patients who neither needed nor qualified for the Medicare Hospice Benefit, according to a report by the Associated Press. The Associated Press article references court documents containing allegations “that a hospice recruiter went door-to-door asking whether residents needed their blood pressure checked.” Prosecutors claim that the hospice then took the patient’s information and used it to bill false claims to Medicare for hospice, according to the AP story.
In recent years, hospice fraud has become a serious problem. In 2009, Frohsin & Barger successfully prosecuted what was at the time the largest Medicare Hospice fraud in the country, resulting in a $24.7 million repayment to the Medicare system by nationwide hospice provider SouthernCare. Since then, numerous lawsuits have been filed by Frohsin & Barger against major hospice companies whose insiders have witnessed the same or similar fraudulent practices. In 2011, the United States intervened in a suit by Frohsin & Barger against Asceracare, the hospice business owned by nursing home giant, Golden Living, formerly known as Beverley Enterprises. In May of this year, the United States intervened in a qui tam whistleblower suit and affirmed allegations in yet another Frohsin & Barger suit filed on behalf of a former executive director of Vitas Corporation, the largest for-profit Medicare hospice provider (which is owned by Chemed Corporation, whose other business unit is Roto-Rooter). In July, still another Frohsin & Barger suit caused HPH Hospice a large provider in central Florida to repay $1,000,000 plus interest, costs, and attorney’s fees to settle allegations that it defrauded the taxpayers and both the Medicare and state-funded Florida Medicaid system.
To report Medicare hospice fraud, contact Frohsin & Barger.
A group of radiation oncology providers based in Pensacola, Florida have agreed to pay $3.5 million to settle allegations of false claims brought under the qui tam, or whistleblower, provisions of the False Claims Act according to a DoJ press release. Richard Koch, a former employee of Gulf Regional Radiation Oncology Centers, Inc. (GRROC), filed the suit in 2012, naming GRROC, Gulf Region Radiation Oncology MSO LLC, Sacred Heart Health System, Inc., West Florida Medical Center Clinic P.A., Emerald Coast Radiation Oncology Center LLC (ECROC), Dr. Gerald Lowrey and Dr. Rod Krentel as defendants.
The suit alleges that between 2007 and 2011 the defendants regularly billed Medicare, Medicaid and TRICARE for radiation oncology services that were not eligible for payment. Koch alleges that (1) many services were not supervised by a physician, as required by regulation, (2) defendants billed for services that were not indicated in the patients’ charts, (3) defendants billed for some services multiple times, and (4) defendants misrepresented the level of service provided in order to increase their reimbursement rate from Medicare, Medicaid and TRICARE.
“Submitting false claims for medical services raises the cost of healthcare for all of us as patients and taxpayers,” said Pamela C. Marsh, U.S. Attorney for the Northern District of Florida. “Patients, employees, and other who suspect billing fraud on the part of the healthcare providers should not hesitate to report such fraud to federal authorities. Healthcare providers – both corporations and individuals – must be held accountable when they submit false information.”
The defendants have agreed to pay $3.5 million to the federal government and the state of Florida. In addition, GRROC, Lowery and Krentel have entered into Integrity Agreements with the Government which require enhanced accountability and monitoring activities be conducted by internal and external reviewers. As a result of the settlement, Richard Koch will receive approximately $609,796 from the federal share of the settlement.
To report healthcare fraud, please contact Frohsin & Barger.
On August 28, 2013, a three-judge panel for the U.S. Court of Appeals for the Seventh Circuit determined that Wisconsin doctor, Dr. Toby Watson, can press on with his suit under the federal False Claims Act even without the aid of a reimbursement expert. Dr. Watson alleges that Dr. Jennifer King-Vassel, a child psychiatrist, wrote off-label prescriptions causing the submission of unlawful Medicaid reimbursements. Off-label prescriptions are written for purposes not approved by the Food and Drug Administration (FDA) after the drug has been approved for at least one use. It is a common and legal practice of physicians when they find the drug useful for another purpose. However, Dr. Watson argues that medications prescribed for non-FDA approved purposes are not eligible for Medicaid reimbursement and that Dr. King-Vassel caused false Medicaid claims to be submitted since she knew her patient was on Medicaid.
A federal district court granted summary judgment to King-Vassel, halting Watson’s suit because he failed to use an expert to explain the Medicaid reimbursement system with regard to prescription drugs. However, the Court of Appeals for the Seventh Circuit reversed after determining that Watson must only show that King-Vassel was aware, or should have been aware, of facts that would lead a reasonable person to realize that she was submitting or causing the submission of false claims. The panel determined that “a reasonable jury could plausibly interpret the evidence Watson assembled to show that King-Vassel recklessly disregarded the fact that [her patient] received Medicaid assistance, and that claims for payment for his prescriptions would be submitted to Medicaid.” The panel continued by stating, “[…] we do not think a jury needs expert testimony to understand that writing a prescription to a person insured by Medicaid will likely cause a claim to be filed with Medicaid.”
To report healthcare fraud, please contact Frohsin & Barger.