LEXINGTON, Ky. – Preferred Care Inc., its Stanton, Kentucky skilled nursing facility, Stanton Nursing and Rehabilitation Center, owner Thomas D. Scott, Preferred Care Partners Management Group, and certain other affiliated entities have agreed to pay $540,000 to the United States and the Commonwealth of Kentucky to resolve allegations of providing worthless services and upcoding.
The United States alleged that Preferred Care Inc., Preferred Care Partners Management Group, Stanton Nursing and Rehabilitation Center, and certain related entities violated the False Claims Act by submitting, or causing the submission of, false claims to Medicare and Medicaid.
The False Claims Act requires healthcare providers to accurately report the level of care provided to patients. Medicare reimburses skilled nursing facilities based on a patient’s resource utilization group, or RUG level, which is determined based on the anticipated amount of skilled therapy and skilled nursing services required by the patient.
The United States alleged that Preferred Care Inc., Preferred Care Partners Management Group, and Stanton Nursing and Rehabilitation Center improperly coded patients for higher amounts of skilled nursing services than they needed or received, resulting in higher payments from Medicare.
The settlement also resolves the government’s allegations that certain patients at Stanton Nursing and Rehabilitation Center received materially substandard or worthless services.
“The United States is committed to protecting our senior community by ensuring that taxpayer dollars are not misspent and nursing facility residents are receiving appropriate, high quality care,” said Robert M. Duncan, Jr., U.S. Attorney for the Eastern District of Kentucky.
The allegations were originally brought in lawsuits filed by defendants’ former employees Susan Helton and Joseph Donchatz, under the qui tam provisions of the False Claims Act.
Preferred Care Inc., Preferred Care Partners Management Group, and Stanton Nursing and Rehabilitation Center are owned or operated by Thomas D. Scott and his affiliated entities. The respective bankruptcy courts approved the settlement on June 26, 2018.
Key Facts
- State: Kentucky
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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