Major Medicare fraud agreement reached
Senior Care Group, which is based in Florida, was under a multiyear investigation by the FBI and the U.S. Department of Health and Human Services. The investigators said they found a pattern of falsified rehabilitation records at two skilled nursing facilities in North Carolina, Sunrise Rehabilitation Center in Nebo and Brookside Rehabilitation Center in Burnsville.
As Senior Care's rehabilitation contractor, EvergreenRehabilitation LLC placed pressure on employees to maximize billing. Evergreen, which is based in Kentucky, then forwarded Senior Care the bills for unnecessary services, prosecutors alleged. In turn, Senior Care wrongfully billed the Medicare program for those services, they added.
According to the prosecutors, the improper billing took place from 2003 through 2006. It involved upcoding and billing for rehabilitation services not covered by Medicare.
As part of the settlement, the company did not admit wrongdoing and will pay $953,375 in quarterly payments over a five-year period.
The company also agreed to have the U.S. Department of Health and Human Services Office of Inspector General monitor it for five years to check for any possible fraud.
In other North Carolina fraud news, a Charlotte woman pleaded guilty to billing the state's Medicaid program for three years for behavioral therapy services that she did not provide and that were not eligible for reimbursement.
Sarah L. Willis, 49, agreed to say that her activities resulted in excess of $1 million and agreed to pay full restitution. Combined, charges of healthcare fraud, money laundering and failure to file tax returns could result in Willis spending as long as 30 years in federal prison.