ATLANTA – England Associates, L.P. d/b/a New London Well being Heart (“New London”) agreed to pay $400,000.00 to resolve allegations that it knowingly submitted false claims to Medicare for rehabilitation remedy providers that weren’t affordable, vital, and expert. The settlement quantity was based mostly on New London’s capacity to pay.
“Nursing residence amenities present necessary providers to our aged; nonetheless, these amenities should uphold the belief positioned in them by billing the federal government just for affordable and vital providers,” mentioned U.S. Lawyer Kurt R. Erskine. “This settlement demonstrates our persevering with efforts to guard sufferers and taxpayers by making certain the that the care supplied to beneficiaries of government-funded well being care applications is dictated by medical wants, not a supplier’s fiscal pursuits.
“When funds from applications like Medicare aren’t used as meant, taxpayers and people who find themselves entitled to these funds endure,” mentioned Philip Wislar, Performing Particular Agent in Cost of FBI Atlanta. “This settlement is the results of the FBI’s dedication to work with our federal and state companions to make sure that federally funded healthcare applications aren’t abused by suppliers.”
“The availability of medical providers must be based mostly on a affected person’s medical wants relatively than the monetary pursuits of suppliers,” mentioned Particular Agent in Cost Tamala E. Miles of the Division of Well being and Human Companies Workplace of Inspector Common (HHS-OIG). “Working carefully with our regulation enforcement companions, we are going to proceed to carry accountable people who endanger the integrity of federal healthcare applications and the beneficiaries they serve.”
The federal government alleged that between January 1, 2011 and November 30, 2014, New London engaged in varied practices that resulted within the submission of claims for unreasonable, pointless, and unskilled providers to Medicare sufferers, together with: (1) presumptively putting sufferers within the Extremely Excessive remedy reimbursement stage, relatively than counting on individualized evaluations to find out the extent of care best suited for every affected person’s medical wants; (2) offering the minimal variety of minutes required to invoice at a given reimbursement stage whereas discouraging the availability of extra remedy past that minimal threshold; (3) ramping up remedy minutes solely in the course of the interval through which billing ranges had been set; and (4) pressuring therapists and sufferers to finish the deliberate minutes of remedy no matter affected person want, and in some instances, for sufferers for whom such remedy would have been harmful.
The Authorities alleges that these preparations violated the False Claims Act, 31 U.S.C. § 3729, et seq.
This case was investigated by the U.S. Lawyer’s Workplace for the Northern District of Georgia, U.S. Division of Well being and Human Companies Workplace of Inspector Common, and the Federal Bureau of Investigation.
The civil settlement was reached by Assistant U.S. Lawyer David A. O’Neal.
The claims resolved by this settlement are allegations solely and there was no willpower of legal responsibility.
For additional data please contact the U.S. Lawyer’s Public Affairs Workplace at USAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Web deal with for the U.S. Lawyer’s Workplace for the Northern District of Georgia is http://www.justice.gov/usao-ndga.