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.”

Reduction of fraud and abuse remains a focus of the government’s efforts to ensure providers accountability. Recently, the Department of Justice (DOJ) announced a $3.199 Million settlement of alleged False Claims Act violations resulting from an ambulance “swapping” arrangement between a skilled nursing home and ambulance service (Regent settlement). Once again, the Department of Justice news release announced that another ambulance provider came under the scrutiny of the Medicare Fraud Strike Force (HEAT), a joint effort of the FBI and HHS-OIG. The Department of Justice announced the prison sentences for the owner, operator and managers of ProMed Medical Transportation, a Southern California ambulance company, as a result of a Medicare fraud scheme involving fraudulent billing for ambulance services. The ambulance company conspired to bill Medicare for transportation that was not necessary, and had the paperwork altered to conceal the patients’ true medical conditions to create fraudulent conditions to justify the services. In addition to the prison sentences ranging from 24 months up to 108 months, the convicted billing manager and supervisor were ordered to pay restitution jointly and severally in the amount of $804,755.

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.

The Department of Justice (DOJ) announced a settlement for claims of substandard nursing care and medically unnecessary rehabilitation therapy wherein Extendicare will pay $38 million to settle False Claims Act allegations. Rehabilitation services have been a frequent target for DOJ investigation and settlement of alleged overpayments. Once again, DOJ brings closure to an investigation of an initiative from the Health Care Fraud Prevention and Enforcement Action Team (HEAT). In addition to HEAT, this settlement arose from an investigation related to the Justice Department’s Elder Justice initiative, which coordinates the Office of Inspector General (OIG) efforts to combat elder abuse, neglect and financial exploitation.

Next time you wonder how serious the government is about anti-kickback law, think about the latest False Claims Act settlement of $30 Million. This settlement was part of the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, partnering Department of Justice and Health and Human Services.