Genesis HealthCare to pay $53.6M to settle 6 false billing cases

Kennett Square, Pa.-based Genesis HealthCare has agreed to pay the federal government $53.6 million to settle six lawsuits alleging some of its facilities violated the False Claims Act, according to the Department of Justice.

The government alleged Foothill Ranch, Calif.-based Skilled Healthcare Group and its subsidiaries violated the False Claims Act by billing Medicare for hospice services provided to patients who were not eligible for those services and improperly billing for certain physician evaluation management services from April 1, 2010, through March 31, 2013. Genesis acquired Skilled Healthcare Group after the alleged improper billing occurred, according to the DOJ.

The government further alleged that from Jan. 1, 2005, through Dec. 31, 2013, Skilled Healthcare Group and its subsidiaries billed government payers for more therapy minutes than certain patients received.

The settlement also resolves allegations that from Jan. 1, 2008, through Sept. 27, 2013, Sun Healthcare submitted false claims to Medicare for medically unnecessary outpatient therapy services provided to patients in Georgia. Genesis acquired Sun Healthcare in December 2012.

"It's disturbing when healthcare companies bill Medicare and Medicaid to care for vulnerable patients, but provide grossly substandard care and medically unnecessary services just to boost company profits," said Special Agent in Charge Steven J. Ryan of HHS' Office of Inspector General. "We will continue to crack down on medical providers who betray the public's trust and the needs of vulnerable patients through fraudulent billing and irresponsible practices."

The allegations against Genesis were originally brought under the qui tam, or whistle-blower, provision of the False Claims Act.

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