“It is in their best interest for companies to make voluntary disclosures and emphasize compliance going forward, as my office will take this sort of cooperation into consideration when determining an appropriate resolution.”False Claims Act cases against skilled nursing operators and their therapy partners have been a common regulatory cudgel, particularly under the previous Resource Utilization Group (RUG) reimbursement system — which directly linked therapy volume with financial incentives.The new Patient-Driven Payment Model (PDPM) for Medicare nursing home reimbursements was designed in large part to remove the temptation to provide questionable therapy services for financial gain, shifting the incentive toward accurately capturing and treating resident conditions.
Pennsylvania Nursing Home Chain To Pay $15.5 Million to Settle False Claims Act Allegations of Inappropriate Therapy.
In some instances, the DOJ claimed, Guardian encouraged clinicians to treat residents with dementia who did not need or want rehabilitation services, as well as those receiving hospice care.The case, which covered allegations spanning from January 2011 through December 2017, was prosecuted by the U.S. Attorney’s Office for the Western District of Pennsylvania, based in Pittsburgh.“Billing federal health care programs for medically unnecessary rehabilitation services not only depletes these programs’ funds but also exploits our most vulnerable citizens,” U.S. attorney Scott Brady said in a statement announcing the deal. Guardian Elder Care, a nursing home operator with more than 50 buildings, will pay $15.5 million to resolve federal accusations of medically inappropriate therapy practices, the Department of Justice announced Wednesday.The Brockway, Pa.-based Guardian faced allegations — brought by a pair of former employees — that the company pressured therapists to perform unnecessary services in order to maximize reimbursements. PITTSBURGH – U.S. Attorney Scott W. Brady announced Wednesday that Guardian Elder Care Holdings Inc. and its related companies will pay $15,466,278 to settle … Such agreements promote compliance and protect vulnerable nursing home residents.
“Our office will continue to aggressively pursue providers who take advantage of our seniors by putting financial gain ahead of patient care.”As is common in False Claims Act cases, the $15.5 million settlement resolves the allegations without Guardian admitting fault or the federal government reaching a formal determination of civil liability. This case was supported by the Department of Justice’s Elder Justice and Nursing Home Initiative, which coordinates the department’s activities combating elder abuse, neglect, and financial exploitation, especially as they impact beneficiaries of Medicare, Medicaid, and other federal health care programs. The year 2020 marks the 150th anniversary of the Department of Justice. Learn more about the history of our agency at Under the qui tam provisions of the False Claims Act, whistleblowers Philippa Krauss and Julie White will split $2.8 million of the settlement money.Guardian — which operates facilities in Pennsylvania, Ohio, and West Virginia — must also enter into a Corporate Integrity Agreement with the Department of Health and Human Services (HHS) Office of the Inspector General (OIG).“Resident care remains our first priority and we are committed to meeting our obligations under this agreement,” Guardian chief compliance officer Patricia McGillan said in a statement provided to SNN. Alex covers the skilled nursing industry for Aging Media Network, with a particular focus on the intersection of finance and policy. We also commend Guardian Elder Care for telling us about its employment of the excluded providers. For more information about the Department’s Elder Justice Initiative and the Elder Justice Task Force, see https://www.justice.gov/elderjustice/.
attorney William McSwain, who represents the Eastern District of Pennsylvania, praised Guardian for its candor during the process.“We also commend Guardian Elder Care for telling us about its employment of the excluded providers,” McSwain said in a statement.
As a result of its employment of these two excluded individuals, Guardian inappropriately received payment for ineligible services.“Too much rehabilitation therapy can actually harm patients, just like giving them too many pills or too much medicine,” said U.S. Attorney William McSwain of the Eastern District of Pennsylvania. Guardian Elder Care Holdings Inc., and related companies Guardian LTC Management Inc., Guardian Elder Care Management Inc., Guardian Elder Care Management I Inc., and Guardian Rehabilitation Services Inc., (Guardian) agreed to pay $15,466,278 to resolve False Claims Act allegations that they knowingly overbilled Medicare and the Federal Employees Health Benefits Program for medically … It is in their best interest for companies to make voluntary disclosures and emphasize compliance going forward, as my office will take this sort of cooperation into consideration when determining an appropriate resolution.”“Billing federal healthcare programs for medically unnecessary rehabilitation services not only depletes these programs’ funds but also exploits our most vulnerable citizens,” said U.S. Attorney Scott W. Brady of the Western District of Pennsylvania.