INDIANAPOLIS — American Senior Communities, the largest nursing home company in America, has agreed to pay nearly $5.6 million to resolve allegations that it violated federal law by submitting false claims to Medicare.
According to the United States Department of Justice, a former employee of a hospice service company doing business with ASC filed a civil complaint, or a “whistleblower lawsuit,” under the False Claims Act in 2017 with the United States District Court for the Southern District of Indiana.
The complaint alleged that ASC defrauded the Medicare program by charging Medicare directly for various therapy services provided to beneficiaries who had been placed on hospice, despite those services already being covered by the beneficiaries’ Medicare hospice coverage.
Based on the investigation, the DOJ stated the estimated loss to the Medicare program was $2,795,522.33. Under the False Claims Act, the government may collect up to three times the loss it incurred, however, plus a fine of between $5,500 to $22,000 for each false bill submitted.
The ASC agreed to pay $5,591, 044.66 to the United States.
“Whistleblowers are critical to protecting public funds from fraud, waste, and abuse,” said U.S. Attorney Zachary A. Myers. “Health care providers who submit false claims or otherwise violate state and federal regulations when billing the United States Government will face consequences.”
Myers said the settlement, announced on Wednesday, demonstrates that federal law enforcement agencies will vigorously investigate reports of false claims and seek to recover funds on behalf of the public.
“Health care providers that submit inappropriate claims to Medicare to boost their own profits compromise the integrity of this important federal health care program,” said Special Agent in Charge Mario M. Pinto of the U.S. Department of Health and Human Services Office of Inspector General.
In agreeing to the settlement, ASC denied all liability under the False Claims Act meaning the claims resolved in the settlement are allegations only. No evidence of injury or harm to patients because of the alleged conduct was uncovered during the investigation, the DOJ added.