Extendicare Health Services agreed to pay the government $38 million for billing Medicaid and Medicare for nursing and rehabilitation services that were “effectively worthless.”
The Justice Department claimed it was the largest settlement against any chain of nursing facilities.
But the company will not be banned from doing business with the government, instead, the Department of Health and Human Services’ inspector general said on Friday:
“Our five-year corporate integrity agreement with Extendicare requires a government-selected quality of care monitor be retained by Extendicare, and additional rigorous provisions designed to ensure Extendicare provides appropriate staffing and monitors the quality of care provided to its residents.”
Because the elderly are vulnerable and Medicaid patients pay little for their healthcare, it is relatively easy for companies to charge the government by using individuals’ Social Security numbers without their informed consent.
Others, since they aren’t paying for it, may settle for substandard care — when in fact the government is paying those companies a rate that should bring top-notch services.
Between 2007 and 2013, Extendicare performed unnecessary services in 33 facilities, “particularly during the patients’ assessment reference periods, so that it could bill Medicare for those patients at the highest per diem rate possible,” prosecutors said.
“The continued viability of Medicare depends, in large part, on the honesty and integrity of the program participants,” said Joyce R. Branda, acting assistant attorney general for the Justice Department’s Civil Division.
“Healthcare providers must make decisions regarding the level of services to be provided based solely on their patients’ clinical needs, and not corporate financial targets,” Banda said.
Two seniors will receive large paychecks to reward them for blowing the whistle on Extendicare.
“Under the False Claims Act, private citizens, known as relators, can bring suit on behalf of the United States and share in any recovery,” prosecutors said.
One will receive $1.8 million while the other will receive $250,000.
