Long Term Care & Senior Living Blog

Last week, the OIG reported charges against 301 individuals for approximately $900 Million in false billing as part of the largest false claim takedown. The takedown focused on a broad range of providers including home health companies, physicians, physical and occupational therapy clinics, infusion clinics, mental health providers, DME suppliers, and compounding pharmacies. Of importance, the takedown focused on staying “a step ahead of emerging fraud trends, including drug diversion, and fraud involving compounded medications and hospice care.”

The U.S. Department of Justice (“DOJ”), in trying to initiate quicker enforcement actions and prosecutions, has created several Elder Justice Task Forces to target health care providers who commit crimes in the service of the elderly. The Task Forces are comprised of representatives from federal, state and local law enforcement, the U.S. Department of Health and Human Services, state adult protective services agencies, long-term care ombudsman programs, U.S. Attorneys’ offices, state Medicaid fraud control units, and state and local prosecutors.

Demonstrating the government’s commitment to combat health care fraud and keeping providers accountable, the U.S. Attorney’s office of Southern District announced that Regent Management Services L.P., a long term provider, agreed to pay approximately $3.199 Million to settle allegations that it received kickbacks from ambulance companies for referrals of Regent’s Medicare and Medicaid patients needing transport in exchange for free or reduced transport costs for its other patients from those ambulance companies.

Next time you wonder how seriously the Department of Justice (DOJ) and its Health Care Fraud Prevention and Enforcement Action Team (HEAT) takes fraud and abuse, be assured they are very serious. This recently announced settlement arose from allegations the DOJ received from a whistleblower that Rite Aid provided gift cards to Medicaid and/or Medicare beneficiaries as an “inducement” to transfer their prescriptions to Rite Aid. Stephanie Yonekura, the Acting U.S. Attorney for Central District of California was quoted as saying the “settlement holds Rite Aid accountable for exerting undue influence on individuals when they make important healthcare decisions about where and when to fill prescriptions.” As part of the settlement, the whistleblower who filed the allegations will receive $508,300 of the settlement.