Thanks to two False Claims Act lawsuits, brought pursuant to the qui tam provisions of the act, Extendicare Health Services, Inc. (Extendicare) and its subsidiary Progressive Step Corp. (ProStep) have agreed to pay $38 million to resolve allegations that it billed Medicare and Medicaid for materially substandard nursing services and for medically unnecessary rehabilitation therapy services according to a DoJ press release.  The settlement resolves allegations that Extendicare billed the federal government for materially substandard nursing services provided in 33 facilities across 8 states.  For example, it failed to follow appropriate protocols to prevent pressure ulcers or falls.  The settlement also resolves allegations that Extendicare provided medically unreasonable and unnecessary rehabilitation therapy services to its Medicare beneficiaries in order to receive the highest per diem rate possible.

“Nursing home residents should not be subject to unreasonable or unnecessary rehabilitation therapy that is dictated by a company’s profits rather than patient needs,” said U.S. Attorney Zane David Memeger for the Eastern District of Pennsylvania.

Relator Tracy Lovvron will receive approximately $1.8 million as her share of the recovery in the RUGS upcoding case and Relator Donald Gallick will receive more than $250,000 as his share in worthless services case.

To report Medicare fraud, please contact Frohsin & Barger.