- North American Health Care and two of its top officers will pay the federal government $30 million to settle charges they billed for unnecessary rehabilitation therapy services.
- According to the Department of Justice, the false claims were submitted to Medicare and TRICARE, the military’s healthcare program, for residents at NAHC’s skilled nursing facilities, most of which are in California.
- The False Claims Act violations occurred at all of NAHC’s SNFs from January 2005 through October 2009, and persisted at three facilities in northern California until December 2011.
The settlement sends a strong message to healthcare organizations that improper billing is wrong and the government is cracking down.
In June, DOJ announced it was pursuing charges against 301 defendants in 36 federal judicial districts accused of Medicare false billing totaling about $900 million. The agency called the “coordinated takedown” the largest in the Medicare Fraud Strike Force’s history.
Under the settlement, Dana Point, CA-based NAHC will pay the government $28.5 million, board chairman John Sorenson will pay $1 million and Margaret Gelvezon, senior vice president of reimbursement analysis, will pay $500,000. According to DOJ, Gelvezon devised the illegal billing scheme and Sorenson reinforced it at NAHC facilities.