Ensign Settles Medicare Fraud Claims for $48M; Whistleblower Amount TBD
The Ensign Group Inc. (Ensign) has agreed to pay $48 million to resolve allegations, under the False Claims Act, that it knowingly submitted or caused the submission of false claims to Medicare for medically unnecessary rehabilitation therapy services, the Justice Department announced today.
Ensign, a skilled nursing provider, allegedly submitted false claims to the government for physical, occupational and speech therapy services provided to Medicare beneficiaries that were not medically necessary. The investigation alleged that Ensign provided therapy to patients whose conditions and diagnoses did not warrant it, solely to increase its reimbursement from Medicare. The government further alleged that Ensign created a corporate culture that improperly incentivized therapists and others to increase the amount of therapy provided to patients to meet planned targets for Medicare revenue. These targets were set without regard to patients’ individual therapy needs and could only be achieved by billing at the highest reimbursement levels. The government also alleged that Ensign billed for inflated amounts of therapy it had not provided and that certain patients were kept in these facilities for periods of time exceeding what was medically necessary for treatment of their conditions.
In addition to the settlement amount, Ensign also agreed that each of its skilled nursing facilities across the nation would be bound by the terms of a Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General (HHS-OIG).
The lawsuit was originally filed by Gloria Patterson and Carol Sanchez, two former Ensign therapists, under the whistleblower provisions of the False Claims Act. The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery. The amount that the whistleblowers will receive has not been determined.
The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments. We have years of experience representing whistleblower clients who uncover fraud of every kind perpetrated against our government including, health care fraud, contract fraud, and tax fraud. Read more about our expertise in False Claims Act cases and how you can take action.