Ensign Group Inc., which runs nursing homes in a number of US states, has consented to pay $48 million to settle Medicare billing fraud allegations that it billed the government for medical procedures that patients didn’t need. The case stems from whistleblower cases brought by Carol Sanchez and Gloria Patterson, two ex-employee therapists who claimed that the nursing home operator conducted rehabilitation therapy that was not always necessary at six of its facilities. The government believes that Medicare fraud took place at Ensign Group facilities from 1999 to 2011. According to the US Department of Justice, Ensign Group provided the therapy to up its Medicare reimbursement.
One whistleblower lawsuit accused Ensign of promoting fraudulent billing by establishing Medicare billing goals that were not reasonable and giving rewards, such as all-expense paid vacations, to employees who met these objectives. The Medicare fraud attorney of one of the plaintiffs said that the only way to meet these goals was to cheat Medicare. As a result, Ensign staff purportedly billed more than the care that was actually provided/needed by patients to meet the incentive goals.
Ensign Group says that even though it is settling, the company never took part in any illegal behavior. It says that it is choosing to resolve the claims to avoid litigation.
The False Claims Act lets whistleblowers who made allegations to expose fraud against the government recover a percentage of what is recovered from the alleged scammers. To ensure you get what you are owed, you should work with a Massachusetts whistleblower law firm that can handle your case from start to finish.
Unfortunately, nursing homes have been known to perpetuate Medicare fraud, including false billing, illegal kickbacks, overbilling, billing for services never rendered, double billing, and other scams. Our Boston whistleblower lawyers represent individuals who wish to come forward and ‘blow the whistle’ on scammers that are bilking the government and taxpayers. Contact Altman & Altman, LLP today to find out whether you have grounds for a Qui Tam case.
O.C. nursing home firm pays $48 million to settle Medicare fraud case, Los Angeles Times, November 19, 2013
False Claims Act, Cornell University
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