Charges from whistleblowers have led to a $48 million settlement between operator The Ensign Group and the U.S. Department of Justice. The settlement was one of the largest of its kind, according to U.S. Attorney André Birotte Jr.
The DOJ officially announced the settlement Nov. 19, though word of a deal first surfaced in April.
The agreement stems from charges that six Ensign skilled nursing facilities in California billed for physical, occupational and speech therapy that either wasn’t needed or wasn’t done. The Mission Viejo, CA-based operator also was accused of keeping residents longer than necessary between 1999 and 2011.
“Skilled nursing facilities that place their own financial interests above the needs of their patients will be held accountable,” said Stuart F. Delery, assistant attorney general for the Justice Department’s Civil Division. “We will continue to advocate for the appropriate use of Medicare funds and the proper care of our senior citizens.”
The government also alleged that Ensign created a culture that improperly incentivized therapists to increase treatments to meet planned Medicare revenue targets.
Attorney Larry P. Zoglin, who represented one of the whistleblowers, told the LA Times that rewards for “audacious goals” included all-expense-paid trips to Hawaii and other vacation spots.
Ensign did not admit any wrongdoing under the settlement, which includes a five-year corporate integrity agreement.
Ensign President and CEO Christopher Christensen stated that the company will continue to make “significant investments in our infrastructure to enhance our compliance program.”
Ensign operates more than 100 facilities in 11 states. A company earnings report indicated the $48 million fine has been paid.
The two whistleblowers, former Ensign therapists, will receive a still-undetermined portion of the settlement, the DOJ stated.