A Texas skilled nursing facility operator will pay $3 million to settle allegations that it received kickbacks from ambulance companies, the Department of Justice announced Monday.

Regent Management Services, headquartered in Galveston, TX, allegedly received kickbacks from ambulance providers in exchange for more lucrative Medicare and Medicaid transport referrals. The settlement is believed to be the first in the country where a healthcare facility, rather than the ambulance company, is held accountable for an “ambulance swapping” arrangement, Office of Inspector General Chief Counsel Gregory Demske said in a press release.

“This settlement sends a message to the healthcare industry that both sides of a swapping arrangement can be held responsible for their improper actions, not just the entity that actually bills Medicare or Medicaid for the services,” Demske said.

Regent, which operates 11 skilled nursing facilities in Texas and one in Nevada, will pay close to $3.2 million to resolve the allegations in order to avoid the “costly burden” of a lawsuit, the company said in a press release sent to McKnight’s on Tuesday. There was no determination of liability in the case.

“Litigation always carries some degree of risk, and these types of healthcare cases are complicated and especially expensive to defend,” the press release stated. “Accordingly, Regent settled this lawsuit because it was in the best interests of Regent, the 12 nursing facilities which Regent manages, and the communities it serves.”

Regent noted the government’s allegations were strictly related to its “method of compensating ambulance transport providers,” and not the quality of care or medical services it provides.