The healthcare system is one of the most important to Americans today. Sadly, it also happens to be rigged with significant fraud and illegal activities as many look to get rich off the suffering and ill health of others.
In May, the Department of Justice (DOJ) confirmed that it had settled with another healthcare provider that was engaging in unlawful activity.
According to a press release from the DOJ, SavaSeniorCare - a nursing home operator based out of Atlanta, Georgia, had settled to pay a fine and agreed to several other penalties after it was found to have committed significant fraudulent activities.
For those who might not know, SavaSeniorCare is a nursing home operator. The organization operates various nursing homes for the elderly, with branches in Georgia and several other states across the country.
According to the DOJ press release, the organization and several of its affiliates had been billing Medicare for several unnecessary therapy services.
Financially-Motivated Fraud
SavaSenior Care found itself in violation of the False Claims Act (FCA) - the same legal provision that many companies tend to violate as they commit their activities.
The FCA is one of the oldest whistleblower protection laws in the United States, and it remains the most powerful in the country. Established in 1863, the law provides whistleblowers the opportunity to earn a percentage of proceeds gotten from prosecuting organizations that dupe the federal government.
If the government investigation leads to a conviction and monetary compensation, the whistleblower is eligible for 15 to 30 percent of the funds received. Rewards can also be quite substantial, especially in cases where criminals pay civil penalties and damage costs.
SavaSeniorCare was accused of purposefully submitting incorrect claims for rehabilitation services over four years - from October 2008 and September 2012. The company had done this in a bid to improve its earnings and make more money.
The management of SavaSeniorCare was accused of especially forcing its senior nursing facility (SNF) staff to meet unrealistic financial goals. Thus, the SNFs themselves were left with no choice but to commit these crimes. In particular, these facilities began billing their patients for some unrealistic and unnecessary services.
Beyond the unrealistic targets, SavaSeniorCare reportedly submitted false claims to Medicaid for co-insurance amounts covering medical rehabilitation services for Medicaid and Medicare.
SavaSeniorCare also submitted incorrect payment claims to Medicare and Medicaid, even though they understood that their services were almost worthless and substantial.
Eventually, five whistleblowers brought the company’s wrong activities to the notice of federal authorities. The whistleblowers are Trammel Kukoyi, Rita Hayward, Terrence Scott, Barbara Roberts, and James Thornton.
Thanks to the information brought by the whistleblowers, the DOJ kicked into gear and began an investigation into SavaSeniorCare’s activities in 2015. Annaliese Imponk, a spokesperson for
SavaSeniorCare Administrative and Consulting LLC explained that the company had spent millions of dollars and several years fighting the allegations. However, they believe that a settlement is the best way forward.
Fines and Inspection Obligations
Under the terms of the agreement, SavaSeniorCare will now pay $11.2 million to clear the case. The fees will be used to settle state and federal charges, although more payments are possible if SavaSeniorCare doesn’t meet several financial contingencies.
Each of the whistleblowers is now eligible for compensation under the provisions of the False Claims Act. However, it is unclear how much they will be given in settlements.
The penalties also impose more than fines on SavaSeniorCare. The organization has agreed to enter into a Corporate Integrity Agreement (CIA) with the Office of the Inspector-General at the Department of Health and Human Services. Under the agreement, SavaSeniorCare will be subject to an audit by an independent review organization.
The audit will cover payments to and from SavaSeniorCare, as well as other related payments made by Medicare. The audit will run for five years, and it will span every institution that SavaSeniorCare operates.
SavaSeniorCarewill also be reviewed by an independent monitor, who will ensure that the quality of services that the company provides is sufficient. Impink pointed out in her statement that the agreement is a positive step for SavaSeniorCare as the organization will be able to deliver on its promise of optimal care and service delivery at all times.
In part, she said:
“We believe that this process will assist us with further enhancing our clinical and quality systems and will provide additional educational support for our center teams. We also hope to take advantage of best practices the monitor can share from other providers they have worked with. As is always the case, we will continue to focus our efforts on supporting our staff who work tirelessly to improve the quality of care and quality of life for those individuals we are privileged to serve.”
Mary Jane Stewart, Mary Jane Stewart, the Acting U.S. Attorney for the Middle District of Tennessee, pointed out that this case marks a terrible occurrence of greed getting too much. Stewart added that companies would need to continually be held accountable for their actions to prevent fraud from getting rampant.
Stewart also thanked the five whistleblowers for their help and information in getting the case wrapped up.