Health Concepts, COO to settle false claims allegations for $2.2 million

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Rhode Island-based skilled nursing provider Health Concepts Ltd., along with the company's chief operating officer, have agreed to pay $2.2 million to settle allegations that the company inflated its Medicare claims.

Health Concepts and its COO, John Gage, allegedly failed to prevent its therapy provider, Massachusetts-based Therapy Resources Management, from regularly overstating the amount of therapy provided to residents Health Concepts residents, the U.S. Attorney's Office for the District of Massachusetts reported Thursday.

The skilled nursing facilities allegedly submitted bills for therapy services that did not occur as reported — TRM's therapists were accused of actually conducting initial evaluations when they said they were provided therapy. The therapists also routinely rounded up the number of therapy minutes provided, despite Medicare rules against estimating or rounding up, the U.S. Attorney's office said.

“Health Concepts put its financial gain ahead of the care of their patients,” said Harold Shaw, special agent in charge of the Federal Bureau of Investigation Boston Field Division. “The FBI will continue to aggressively investigate skilled nursing facilities that inflate their billing and exploit the nation's healthcare system.”

Health Concepts has increased oversight of its records and billing practices in the wake of the federal investigation, the company said in a statement to McKnight's. The company has also partnered with a new therapy company, and appointed a new corporate compliance officer to “help ensure accurate fiscal compliance.”

“Health Concepts has always strived to maintain the highest standards of ethics and integrity and these recent steps are the latest in a long line of initiatives toward that end,” the statement reads. “Patient care was not a factor in this matter. The company's dedication to the provision of high quality patient care remains steadfast."