Nursing Home Provider Settles for $48 Million for Submitting False Therapy Claims.

On November 19, the Department of Justice (DOJ) announced that The Ensign Group Inc., a skilled nursing provider, settled for $48 million for allegedly submitting false claims to Medicare for medically unnecessary rehabilitation therapy services.  Six of Ensign’s skilled nursing facilities in California allegedly submitted false claims for services that were not medically necessary between January 1, 1999 and August 31, 2011.  According to the DOJ, Ensign established a corporate culture that created incentives for therapists to increase therapy amounts for individuals and bill at the highest reimbursement levels, without considering individual therapy needs.  Ensign also kept patients in the facilities for periods of time that exceeded medical necessity.

In addition to paying the settlement amount, Ensign entered into a Corporate Integrity Agreement (CIA)  with the Department of Health and Human Services Office of Inspector General.  Each of Ensign’s skilled nursing facilities across the nation will be required to comply with the terms of the CIA.

The DOJ justice news on the nursing home settlement is available at:

http://www.justice.gov/opa/pr/2013/November/12-civ-1235.html.

Department of Justice.  “Nursing Home Operator to Pay $48 Million to Resolve Allegations That Six California Facilities Billed for Unnecessary Therapy.”  Justice News.  19 Nov. 2013.

About the Author

Ms. Shuman assists health care organizations to develop, implement and evaluate their compliance programs and HIPAA privacy programs. Ms. Shuman specializes in our firm’s HIPAA Privacy services, including leading privacy investigations, breach risk assessments, breach notification letters, breach reporting to the Office for Civil Rights and corrective actions plans. She specializes in serving as Interim Privacy Officer for large health care systems, managed care organizations, comprehensive cancer center and health care business associate.