Genesis to Pay $53.6 Million to Settle Medicare Fraud Claims Against Companies It Acquired Genesis Healthcare Inc.—which owns and operates through its subsidiaries skilled nursing facilities, assisted/senior living facilities, and a rehabilitation therapy business—will pay the federal government $53,639,288 to settle six federal lawsuits and investigations alleging Medicare fraud. The allegations include false claims to Medicare, Tricare and Medicaid. Specifically, the therapy allegations include: ... News in Brief
Free
News in Brief  |   August 01, 2017
Genesis to Pay $53.6 Million to Settle Medicare Fraud Claims Against Companies It Acquired
Author Notes
Article Information
Practice Management / News in Brief
News in Brief   |   August 01, 2017
Genesis to Pay $53.6 Million to Settle Medicare Fraud Claims Against Companies It Acquired
The ASHA Leader, August 2017, Vol. 22, 12. doi:10.1044/leader.NIB1.22082017.12
The ASHA Leader, August 2017, Vol. 22, 12. doi:10.1044/leader.NIB1.22082017.12
Genesis Healthcare Inc.—which owns and operates through its subsidiaries skilled nursing facilities, assisted/senior living facilities, and a rehabilitation therapy business—will pay the federal government $53,639,288 to settle six federal lawsuits and investigations alleging Medicare fraud.
The allegations include false claims to Medicare, Tricare and Medicaid. Specifically, the therapy allegations include:
  • Billing for therapy that was not medically necessary.

  • Billing for more therapy minutes than the patients received.

  • Assigning patients to a category of skilled therapy that was higher than necessary (a practice known as upcoding) to increase reimbursement levels.

  • Billing for outpatient therapy services that were not medically necessary or unskilled.

Other allegations include billing for hospice services for patients who were not terminally ill; billing inappropriately for certain physician evaluation management services; and failing to meet essential nursing home requirements.
The allegations were levied against companies and facilities acquired by Genesis since 2012: Skilled Healthcare Group and its subsidiaries, Skilled Healthcare LLC and Creedside Hospice II LLC; Sun Healthcare Group Inc., SunDance Rehabilitation, and SunDance Rehabilitation Corp. Some of the alleged activities took place before Genesis acquired the companies.
Genesis, headquartered in Kennett Square, Pennsylvania, is one of the nation’s larger investor-owned skilled nursing, senior living and rehabilitation services providers, with more than 500 skilled nursing facilities in 34 states.
The settlement resolves allegations originally brought in lawsuits filed under the whistleblower provisions of the False Claims Act by seven former employees of the companies acquired by Genesis.
Commenting on the settlement, Garry Pezzano, Genesis senior vice president for clinical practice says, “The Department of Justice settlement involved successor matters, prior to Genesis ownership. We are pleased that there is resolution. We remain committed to providing quality care and services to our patients and residents.”
The whistleblowers will receive a combined $9.67 million as their share of the recovery in this case. Meanwhile, the Department of Justice will continue pursuing investigations of Medicare fraud, says Joyce R. Branda, deputy assistant attorney general for the Justice Department’s Civil Division. She notes, “Therapists who believe they’ve witnessed Medicare fraud can contact the Department of Health and Human Services’ Office of Inspector General Hotline” at 1-800-HHS-TIPS.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
August 2017
Volume 22, Issue 8