Providence-based skilled nursing facility operator Health Concepts, Ltd., and its Chief Operating Officer, John Gage, have agreed to pay $2.2 million to resolve allegations concerning inflated Medicare claims.
“This settlement is another in a series of resolutions involving inflated Medicare billing at skilled nursing facilities,” said United States Attorney Carmen M. Ortiz. “We continue our efforts to ensure that the provision of care in nursing facilities is based on patients’ clinical needs rather than the financial interests of the companies providing care.”
The agreement announced on Wednesday resolved allegations concerning rehabilitation therapy that Massachusetts-based Therapy Resources Management (TRM) purportedly provided at Health Concepts facilities in Rhode Island. The settlement resolves allegations that Health Concepts and Mr. Gage failed to take sufficient steps to prevent TRM from engaging in a pattern and practice of fraudulently inflating the reported amounts of therapy provided to Medicare Part A patients in Health Concepts facilities. Specifically, the facilities submitted bills for therapy that allegedly did not occur as reported, because the therapists were actually conducting initial evaluations when they claimed to be providing therapy, and because the therapists reported therapy time using estimates that often were rounded up from the actual minutes of therapy provided, despite Medicare rules specifically prohibiting the reporting of estimated or rounded numbers of minutes.
“Health Concepts put its financial gain ahead of the care of their patients,” said Harold H. Shaw, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division. “The FBI will continue to aggressively investigate skilled nursing facilities that inflate their billing and exploit the nation’s healthcare system.”