6 firms pay $6M in whistleblower case
Six Maryland companies – four skilled nursing facilities and two financial consultants – have reached an agreement over a fraudulent billing claim from the U.S. Department of Justice, with the overall settlement totaling $6 million.
The U.S. Attorney's Office in Baltimore announced the resolution in March, which stemmed from a civil lawsuit led under the whistleblower provisions of the False Claims Act. The government joined the suit, accusing the defendants of systematic false reporting of the number of minutes skilled therapy was delivered between January 2010 and January 2014.
It was alleged that the accused mischaracterized the medical necessity of therapy in numerous cases. By increasing minutes in many instances over the four-year period, the company was able to bill patients at higher reimbursement rates.
“The United States alleged that the consulting companies and the skilled nursing facilities put systems in place to maximize Medicare and Tricare reimbursement and that caused the submissions of claims for therapy services that were either not provided or that were unnecessary,” the Department of Justice said in its news release announcing the settlement.
Caring Heart Rehabilitation and Nursing Center in Philadelphia agreed to pay the United States nearly $1.3 million. Other amounts providers agreed to pay were: Riverview Rehabilitation and Health Center in Essex, MD ($1.2 million); Gowanda Nursing Home in Buffalo ($811,153); and Ocean Promenade Nursing Center in Rockaway Park, NY ($608,365).
In addition to those sums, GHC Clinical Consultants agreed to pay $1.8 million and Global Healthcare Services Group $190,000. Both consulting firms are based in New Jersey, according to the U.S. Attorney's Office.