ATLANTA – England Associates, LP d/b/a New London Health Center (“New London”) agreed to pay $400,000.00 to resolve allegations that Medicare knowingly filed false claims for rehabilitation therapy benefits that were not were appropriate, necessary and qualified. The settlement amount was based on New London’s ability to pay.
“Nursing homes provide important services to our elderly; However, these entities must maintain the trust placed in them by only charging the government for reasonable and necessary services,” said U.S. Attorney Kurt R. Erskine. “This settlement demonstrates our ongoing efforts to protect patients and taxpayers by ensuring that care for beneficiaries of federally funded healthcare programs is driven by clinical needs and not a provider’s tax interests.
“When funds from programs like Medicare are not used as intended, taxpayers and those who are entitled to those funds suffer,” said Philip Wislar, acting special agent for the FBI Atlanta. “This settlement comes as a result of the FBI’s commitment to work with our federal and state partners to ensure that federally funded healthcare programs are not abused by providers.”
“The provision of medical services should be based on a patient’s medical needs and not on the financial interests of providers,” said Tamala E. Miles, acting special representative for the Office of the Inspector General (HHS-OIG) of the Department of Health and Human Services. “Working closely with our law enforcement partners, we will continue to hold accountable those who compromise the integrity of federal health programs and the beneficiaries they serve.”
The government alleged that between January 1, 2011 and November 30, 2014, New London engaged in various practices that resulted in the filing of claims of improper, unnecessary, and unqualified services provided to Medicare patients, including: (1) alleged Placing patients in the Ultra High Therapy reimbursement level, rather than relying on individual assessments to determine the level of treatment most appropriate for each patient’s clinical needs; (2) providing the minimum number of minutes required for billing at a given reimbursement level while discouraging the delivery of additional therapies beyond that minimum threshold; (3) increase in therapy minutes only during the period in which billing levels have been established; and (4) to pressure therapists and patients to complete scheduled minutes of therapy regardless of patient need, and in some cases patients for whom such therapy would have been dangerous.
The government alleges that these agreements violate the False Claims Act, 31 USC § 3729 et seq.
This case was investigated by the US Attorney for the Northern District of Georgia, the US Department of Health and Human Services Inspector General and the Federal Bureau of Investigation.
The civil settlement was reached by Assistant US Attorney David A. O’Neal.
The claims settled by this settlement are allegations only and no liability has been determined.
For more information, please contact the US Attorney’s Public Affairs Office at [email protected] or (404) 581-6016. The web address of the US Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.