A collective of healthcare providers is being instructed to pay $21.3m after regulators discovered fraudulent medical services and billing claims.

The fraud claims focus on the Grand Health Care System (The Grand) and 12 affiliated skilled nursing facilities under Strauss Ventures LLC’s umbrella.

Senior staff working in the collective are reportedly in breach of the False Claims Act for billing, carrying out, and falsifying medical care. This concludes a long-running whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Stacey Rosenberger and Kelley Retig, two former therapy practitioners working at The Grand.

Healthcare Collective fined for fraudulent billings

Strauss Ventures has agreed to pay $21.5 m to settle a breach of the False Claims Act regarding Medicare Part A and TRICARE claims. The 12 associated facilities under The Grand Health Care scheme knowingly submitted false claims for rehabilitation therapy for their residents.

According to the Justice Department, The Grand, as a collective, would put patients through more therapy or procedures than were necessary. In other cases, The Grand would submit falsified claims of therapy and care work being carried out when, in fact, no work was undertaken.

The reasoning for these illegitimate and falsified claims was from a now redundant senior management and decision-making level at The Grand. Due to quotas and financial targets, staff were pressured to meet and offer the highest and lengthiest care to keep meeting these targets.

The Justice Department release stated that The Grand “directed that no more than three patients be discharged from any facility per week and instructed that no Medicare Part A patients should be discharged from rehabilitation therapy unless it had been discussed with corporate officials.”

The Grand admits fault

The Grand admitted to falsifying the number of therapy minutes patients received upon the electronic management system to track patient records. The collective also admitted that supervisory officials proscribed treatment without consulting or evaluating patients’ medical records.

“Today’s settlement protects patients and taxpayers by ensuring that medical treatment is dictated by patient need and not by financial motive,” said U.S. Attorney Carla B. Freedman for the Northern District of New York. “Skilled nursing facilities provide important services to a vulnerable population, and we will continue to hold them accountable when they provide patients with unnecessary services and falsify records.”

The Grand has now agreed to settle the financial penalties levied against them and entered into a five-year Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General (HHS-OIG). The HHS-OIG will now send an independent regulator to assess The Grand and the facilities under their remit regarding Medicare Part A and TRICARE agreements.

Stacey Rosenberger and Kelley Retig will receive $4,047,000 of the settlement proceeds and conclude the whistleblower suit.

Image: Ideogram.

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