The Department of Justice recently announced that Genesis Healthcare Inc. will pay $53.6 million to resolve  allegations that it and its subsidiaries submitted false claims to government healthcare programs for medically unnecessary therapy and hospice services, and grossly substandard nursing care.

The case was brought by 7 whistleblowers who brought 6 separate federal lawsuits in the Northern District of California, the District of Nevada, the Northern District of Georgia, and the Western District of Missouri. The whistleblower reward is a combined $9.67 million.

This settlement resolves a slew of allegations including (but not limited to): Billing Medicare for hospice services for patients who were not terminally ill; billing for inappropriately for certain physician-evaluation management services; submitting false claims by providing therapy to certain patients longer than medically necessary; fraudulently assigning patients a higher Resource Utilization Group (RUG) level than necessary; submitting false claims to Medicare Part B by billing for outpatient therapy services provided in the State of Georgia that were not medically necessary or unskilled in nature; submitting false claims to the Medicare and Medi-Cal programs at certain of its nursing homes for services that were grossly substandard and/or worthless and therefore ineligible for payment.

U. S. Attorney John Horn for the Northern District of Georgia said:

Health care providers that falsify claims for unauthorized or unnecessary services steal precious taxpayer dollars, and we will aggressively seek to recover those funds for the program that needs them.

Special Agent in Charge Steven J. Ryan of the Department of Health and Human Services, Office of Inspector General (HHS-OIG) said:

It’s disturbing when health care companies bill Medicare and Medicaid to care for vulnerable patients, but provide grossly substandard care and medically unnecessary services just to boost company profits…We will continue to crack down on medical providers who betray the public’s trust and the needs of vulnerable patients through fraudulent billing and irresponsible practices.

Nolan Auerbach & White is a law firm that prosecutes healthcare fraud cases for courageous whistleblowers under the qui tam provisions of the False Claims Act.  “Doing the right thing matters” is our firm mantra, and making sure that justice prevails is our goal. More information for potential whistleblowers is located on our main website.