Home Nurse Facilities Atlanta’s National Chain of Skilled Nursing Facilities to Pay $ 11.2 Million to Resolve Claims of Poor Care Delivery and Medically Unnecessary Therapy Services | USAO-EDPA

Atlanta’s National Chain of Skilled Nursing Facilities to Pay $ 11.2 Million to Resolve Claims of Poor Care Delivery and Medically Unnecessary Therapy Services | USAO-EDPA

0


PHILADELPHIA – Acting U.S. Attorney Jennifer Arbittier Williams has announced that SavaSeniorCare LLC and related entities (Sava) have agreed to pay $ 11.2 million, plus additional amounts if certain financial contingencies arise, for resolve allegations that she violated the False Claims Act by causing nursing facilities (SNFs) to bill Medicare for rehabilitative therapy services that were not reasonable, necessary, or qualified, and resolve the allegations that Sava billed Medicare and Medicaid for substandard, highly skilled nursing services. Sava, based in Atlanta, Georgia, currently owns and operates more than 160 skilled nursing facilities across the country, including three facilities in Pennsylvania.

“Nursing home residents should not be at the mercy of nursing home operators who put their own economic gains ahead of the needs of residents, and we will continue to aggressively pursue operators who charge Medicare and Medicaid for substandard care, ”Acting US attorney Williams said. “This regulation holds Sava accountable, and the resulting corporate integrity agreement should ensure that Sava provides quality care to older people and treats its residents with dignity and respect.”

This settlement resolves four False Claims Act lawsuits, one in the United States District Court for the Eastern District of Pennsylvania and three consolidated in the United States District Court for the Central District of Tennessee. The lawsuits allege that Sava submitted bogus claims for rehab therapy services while engaging in a systematic effort to increase her Medicare billings. Through company-wide policies and practices, Sava is said to have placed significant pressure on its SNFs designed to meet unrealistic financial goals, resulting in the provision of medically unreasonable, unnecessary and unqualified services to Medicare patients. . Sava allegedly set these ambitious, forward-looking corporate goals for the highest Medicare reimbursement rates in order to dramatically increase Sava’s revenue without considering the real clinical needs of his patients, and then pressured his staff to make sure they did. ‘he achieves these goals. Sava is also said to have delayed the discharge of patients from its facilities in order to increase its health insurance payments, even if the patients were medically ready to be discharged.

This settlement also resolves allegations that between October 1, 2008 and September 30, 2012, Sava submitted false claims to Medicaid for coinsurance amounts related to rehabilitation therapy services for beneficiaries who were eligible for both Medicare and Medicaid.

Additionally, this settlement resolves allegations that between January 1, 2013 and December 31, 2018, Sava submitted false claims to Medicare and Medicaid for grossly and materially inferior and / or worthless qualified nursing services, which were caused in large part by Sava’s inability to provide a sufficient number of trained nurses to adequately care for the residents of her nursing home. This failure of care would have resulted in preventable pressure ulcers, preventable falls and preventable medication errors.

“Nursing home operators will be held to account when they put their own financial interests ahead of the needs of their residents,” said Acting Assistant Attorney General Brian M. Boynton of the Civil Division of the Department of Justice. “This regulation demonstrates the ministry’s continued commitment to aggressively prosecute carriers who bill Medicare and Medicaid for unnecessary and grossly substandard services and who fail to adequately support residents in their care.”

As part of the settlement with the United States and separate settlements with the participating states, Sava has agreed to pay a total of approximately $ 11.2 million, plus additional amounts should certain financial contingencies arise.

Along with this settlement, Sava also entered into a chain-wide five-year Corporate Integrity Agreement (CIA) with the Office of the Inspector General of the Department of Health and Human Services (HHS- OIG) which requires an independent organization to annually review patient stays and associated Medicare paid claims for those stays, including the provision of rehabilitative therapy services to ensure they are reasonable and necessary to improve, maintain or slow the deterioration of the patient’s condition, or restore the patient’s previous level of function. In addition, Sava is required to hire an independent monitor to review the quality of resident care. CIAs promote compliance and protect vulnerable residents of nursing homes.

The cases were handled by the United States Attorney’s Offices in the Eastern District of Pennsylvania and the Central District of Tennessee, the Commercial Litigation Division of the Civil Division and the HHS-OIG, with assistance from the United States Prosecutor’s Offices in the Southern District of Texas and the District of Texas and the National Association of Medicaid Fraud Control Units. At the United States Attorney’s Office for the Eastern District of Pennsylvania, Assistant United States Attorney David A. Degnan, Assistant United States Attorney Gerald B. Sullivan, and Auditor George R. Niedzwicki conducted the investigation and resolution.

The cases are captioned United States, et al. ex rel. Doe, et al. v. SavaSeniorCare, Inc., et al., Civil action n ° 16-CV-0840 (ED Pa.); United States ex rel. Hayward v. SavaSeniorCare, LLC, et al., No. 3: 11-0821 (MD Tenn.); United States ex rel. Scott v. SavaSeniorCare Administrative Services, LLC, 3: 15-0404 (MD Tenn.); and United States ex rel. Kukoyi v. Sava Senior Care, LLC, et al., No. 3: 15-1102 (MD Tenn.). The rapporteur in the Eastern District of Pennsylvania action is represented by David T. Marks of Marks Balette Giessel & Young, PC, Thomas Sheridan of Sheridan & Murray, LLC and Joseph Trautwein of Joseph Trautwein & Associates, LLC.

The claims settled by this agreement are only allegations, and there has been no determination of liability.