ATLANTA – England Associates, L.P. d/b/a New London Health Center (“New London”) agreed to pay $400,000.00 to resolve allegations that it knowingly submitted false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary, and skilled. The settlement amount was based on New London’s ability to pay.
“Nursing home facilities provide important services to our elderly; however, those facilities must uphold the trust placed in them by billing the government only for reasonable and necessary services,” said U.S. Attorney Kurt R. Erskine. “This settlement demonstrates our continuing efforts to protect patients and taxpayers by ensuring the that the care provided to beneficiaries of government-funded health care programs is dictated by clinical needs, not a provider’s fiscal interests.
“When funds from programs like Medicare are not used as intended, taxpayers and people who are entitled to those funds suffer,” said Philip Wislar, Acting Special Agent in Charge of FBI Atlanta. “This settlement is the 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 rather than the financial interests of providers,” said Special Agent in Charge Tamala E. Miles of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Working closely with our law enforcement partners, we will continue to hold accountable individuals who endanger the integrity of federal healthcare 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 submission of claims for unreasonable, unnecessary, and unskilled services to Medicare patients, including: (1) presumptively placing patients in the Ultra High therapy reimbursement level, rather than relying on individualized evaluations to determine the level of care most suitable for each patient’s clinical needs; (2) providing the minimum number of minutes required to bill at a given reimbursement level while discouraging the provision of additional therapy beyond that minimum threshold; (3) ramping up therapy minutes only during the period in which billing levels were set; and (4) pressuring therapists and patients to complete the planned minutes of therapy regardless of patient need, and in some cases, for patients for whom such therapy would have been dangerous.
The Government alleges that these arrangements violated the False Claims Act, 31 U.S.C. § 3729, et seq.
This case was investigated by the U.S. Attorney’s Office for the Northern District of Georgia, U.S. Department of Health and Human Services Office of Inspector General, and the Federal Bureau of Investigation.
The civil settlement was reached by Assistant U.S. Attorney David A. O’Neal.
The claims resolved by this settlement are allegations only and there has been no determination of liability.
For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.