Self-reporting False Claims Act violation averts litigation

Long-term care providers would do well to know the lesson from one Pennsylvania continuing care facility, which averted costly litigation when it discovered and later reported irregularities of more than $1 million in Medicare claims.

Asbury Health Center, a continuing care retirement community, collected $1.3 million in Medicare payments for post-hospital nursing services that weren't backed by the physician certifications and recertifications that Medicare regulations require, according to the U.S. Attorney's Office. Medicare requires providers to obtain the document upon admission to a post-acute facility, and recertification within 14 days of admission and every 30 days thereafter.

The facility reportedly discovered the error, a “signature technicality,” during a compliance audit. In July 2014 it notified the U.S. Attorney's Office and the Office of Inspector General of the Department of Health and Human Services of the error. The U.S. Attorney's office said that while the error constituted a False Claims Act violation, Asbury Health Center's self-reporting obviated litigation.