Genesis Healthcare Inc., False Claims Act, Pennsylvania 2013

Grimy Times Exclusive: Genesis Healthcare Inc., a skilled nursing facility operator with headquarters in Kennett Square, Pennsylvania, has agreed to pay the federal government $53,639,288.04 to settle six federal lawsuits and investigations alleging that the company and its subsidiaries violated the False Claims Act by causing the submission of false claims to government health care programs for medically unnecessary therapy and hospice services.

The six lawsuits and investigations, which were filed and conducted between 2003 and 2013, alleged that Genesis and its subsidiaries knowingly submitted or caused to be submitted false claims to Medicare, TRICARE, and Medicaid for services performed at various facilities across the country.

The allegations included claims that Genesis and its subsidiaries billed for hospice services for patients who were not terminally ill, billed inappropriately for certain physician evaluation management services, provided therapy to patients longer than medically necessary, and fraudulently assigned patients a higher Resource Utilization Group (RUG) level than necessary.

“We will continue to hold health care providers accountable if they bill for unnecessary or substandard services or treatment,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “Today’s settlement demonstrates our unwavering commitment to protect federal health care programs against unscrupulous providers.”

The settlement resolves four sets of allegations, including claims that Skilled Healthcare Group Inc. and its subsidiaries, Skilled Healthcare LLC and Creekside Hospice II LLC, knowingly submitted or caused to be submitted false claims to Medicare for services performed at the Creekside Hospice facility in Las Vegas, Nevada between April 1, 2010 and March 31, 2013.

The settlement also resolves allegations that Sun Healthcare Group Inc., SunDance Rehabilitation Agency Inc., and SunDance Rehabilitation Corp. knowingly submitted or caused the submission of false claims to Medicare Part B by billing for outpatient therapy services provided in the State of Georgia between January 1, 2008 and September 27, 2013.

Genesis Healthcare Inc., which owns and operates through its subsidiaries skilled nursing facilities, assisted/senior living facilities, and a rehabilitation therapy business, has agreed to pay $53.6 million to settle the allegations, including interest.

Mandatory Facts: Defendant: Genesis Healthcare Inc., Crime: False Claims Act, State: Pennsylvania, Year: 2013, Sentence: $53,639,288.04 fine.

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