More than half of fines and settlements from $2.3 billion recouped through healthcare fraud investigations went back into Medicare Trust Funds last year, according to a report issued Friday by the Health and Human Services Office of Inspector General.
The Department of Justice opened 1,139 new criminal healthcare fraud investigations in fiscal year 2018, with federal prosecutors filing criminal charges in 572 cases involving 872 defendants. The Health Care Fraud and Abuse Control Program also pursued 795 civil actions, including false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties and administrative recoveries related to provider self-disclosures.
The FY2018 report noted several actions against skilled nursing providers, among them:
- An October 2017 settlement in which Catholic Health System agreed to pay $6 million in connection with false claims tied to ultra-high therapy coding at several long-and short-term skilled nursing care and post-acute care facilities.
- A June 2018 settlement with Signature Healthcare. The company agreed to pay $30 million to resolve civil FCA allegations over its own ultra-high therapy billing.
- A July 2018, $10 million deal with Southern SNF Management, Inc., Dynamic Rehab and nine affiliated skilled nursing facilities in Florida and Alabama addressing “therapy practices (that) encouraged the provision of medically unreasonable and unnecessary therapy without regard for patients’ individual clinical needs.”
- A June 2018 settlement with Comanche County Hospital Authority over allegations it billed for emergency ambulance transportation in non-emergency situations such as skilled nursing transfers. The case cost Comanche $566,806.
Other skilled nursing providers were hit over their employment of excluded individuals and for failure to educate nurses on medication administration and pain management policies.
The high enforcement and penalty numbers came even as Congress cut $20.2 million from the healthcare fraud enforcement budget.
