Plum Healthcare Group will pay $451,439 to settle a whistleblower lawsuit claiming false Medicare billing at its skilled nursing facility in San Marcos, CA, the Department of Justice announced Tuesday.
An employee at McKinley Park Care Center, a part of Azalea Holdings, billed for non-existent or upcoded services, authorities said.
Further, corporate management at Plum did not conduct an adequate investigation into the allegations nor fully repay Medicare for known shortcomings, according to investigators with the of the U.S. Health and Human Services’ Office of the Inspector General and the FBI. The company also did not appropriately disclose why it was issuing the repayment, they added. Plum is the second-largest skilled nursing operator in California.
“Defendants knew they obtained the overpayments because internal reports informed defendants’ management about the scope and extent of the overpayments,” the settlement agreement says.
Attempts made by McKnight’s Long-Term Care News to obtain comment from Plum were unsuccessful Tuesday. Federal officials said the settlement agreement contained “allegations only,” with “no determination of liability.”
“It’s unacceptable to stick taxpayers with a bill for healthcare services that were never provided and for healthcare executives to look the other way when these false claims were submitted to Medicare,” said OIG Special Agent in Charge Steven J. Ryan.
“Medicare participants who fail to voluntarily disclose fraud risk significant consequences,” added Acting U.S. Attorney Talbert in the DOJ statement.
Former Plum employee Kristine Davenport was the whistleblower who filed the False Claims Act complaint in 2017. She will receive more than $90,000. The alleged wrongdoings took place from June 2012 to October 2015.
The settlement agreement was dated June 14 but filed under seal and announced Tuesday by the DOJ. Plum CEO Cory Christensen signed the agreement May 24, three days before HHS counsel did.
