Healthcare Compliance Perspective:
Knowingly submitting claims for services provided that are considered worthless is a violation of the False Claims Act and can result in criminal, civil, and financial penalties. Furthermore, certain healthcare organizations or providers are susceptible to losing their professional license as well as excluded from participating in Federal health care programs in the future.
The owners and operators of a large nonprofit and other companies have agreed to a pay $1.25 million to settle claims of providing poor care in their facilities.
Failure to provide adequate nourishment, multiple falls, development of pressure ulcers, prescribed medications and understaffing were but a few of specific areas cited as directly harmful and abusive to the residents. These concerns did not address the numerous other physical, psychological and emotionally harmful effects that the alleged poor care fostered.
The allegations related to these charges stem from operations in the facility from October 2005 through May 2012, when the nursing home was being managed by the cited companies and the non-profit. The U.S. DOJ charged that during this period the managing company submitted claims to Medicare and Medicaid for “providing effectively worthless services to the nursing home residents.” The government also claims that the managing company diverted reimbursement funds received for one facility to other purposes and entities, and this left the facility with the inability to “pay for its basic operations, including food, heat, air-conditioning, pest control and cleaning.”
The initial lawsuit was filed under the qui tam provisions of the False Claims Act by the new owner and landlord of the one specific skilled nursing facility
