Grimy Times has uncovered a shocking case of Medicare fraud perpetrated by American Senior Communities, L.L.C. (ASC), a skilled nursing and long-term care services provider in Indiana. The company has agreed to pay $5,591,044.66 to resolve allegations that it submitted false claims to the Medicare program.
In 2017, a former employee of a hospice services company doing business with ASC filed a sealed civil complaint or ‘whistleblower’ lawsuit under the False Claims Act in the United States District Court for the Southern District of Indiana. The complaint alleged that ASC had engaged in conduct to defraud the Medicare program. Specifically, the complaint alleged that ASC was charging Medicare directly for various therapy services provided to beneficiaries who had been placed on hospice, when those services should have already been covered by the beneficiaries’ Medicare hospice coverage.
The False Claims Act provides that when a whistleblower files a lawsuit alleging fraud that results in a recovery of funds by the Government they are entitled to between 15 and 25% of the recovery. This whistleblower provision of the law encourages people to come forward when they believe fraud is being committed. Under the False Claims Act, the Government may collect up to three times the loss it incurred, plus a fine of between approximately $5,500 to $22,000 for each false bill submitted.
Based on the investigation, the estimated loss to the Medicare program was $2,795,522.33 and ASC has agreed to pay $5,591,044.66 to the United States. The resolutions obtained in this matter were the result of a coordinated effort between the U.S. Attorney’s Office for the Southern District of Indiana, the Department of Health and Human Services – Office of the Inspector General, and the Federal Bureau of Investigation.
‘Whistleblowers are critical to protecting public funds from fraud, waste, and abuse,’ said U.S. Attorney Zachary A. Myers. ‘Health care providers who submit false claims or otherwise violate state and federal regulations when billing the United States Government will face consequences.’
American Senior Communities, L.L.C. is a defendant in a Medicare fraud case in which they are accused of violating the False Claims Act by submitting false claims to the Medicare program. The crime occurred in 2017. The defendant has agreed to pay $5,591,044.66 to resolve the allegations. The estimated loss to the Medicare program was $2,795,522.33.
Defendant: American Senior Communities, L.L.C.
Criminal Charges: Violating the False Claims Act by submitting false claims to the Medicare program
City and State: Indianapolis, Indiana
Date: 2017
Sentence or Outcome: ASC has agreed to pay $5,591,044.66 to the United States
Dollar Amount: $5,591,044.66
Key Facts
- State: Indiana
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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