Indiana’s largest nursing home operator was found to be engaged in Medicare fraud. According to the Indianapolis Star, American Senior Communities (ASC) has agreed to pay $5.5 million in a settlement over allegations of submitting false claims to the federal Medicare program.
The IndyStar article, by Johnny Magdaleno and Tony Cook, states that this settlement arrived just over 5 years after the federal lawsuit was brought against ASC with the help of a whistleblower. The article further reports that the whistleblower “alleged that ASC charged Medicare for therapy services provided to hospice care patients after those services should have already been covered by the patients’ Medicare hospice coverage.”
According to the article, the whistleblower flagged the fraudulent behavior to colleagues in 2015. The report goes on to discuss that some of the whistleblower’s colleagues met with ASC corporate employees at the company’s corporate headquarters in Indianapolis to discuss the issue, but the whistleblower says he was later told by a colleague who attended that meeting that ASC was going to continue the Medicare billing practice.
The lawsuit against ASC states that the whistleblower knew of similar fraudulent activity that occurred “many times at many different ASC facilities over a lengthy period of time (more than five years).”
According to the article, the U.S. attorney’s office estimated the fraud caused a loss of over $2.7 million to the Medicare program.
According to the article, the IndyStar is currently working to find which of the 78 ASC nursing homes in Indiana were involved in the Medicare fraud.
“Health care providers that submit inappropriate claims to Medicare to boost their own profits compromise the integrity of this important federal health care program,” – Mario M. Pinto, Special Agent, U.S. Department of Health and Human Services Office of Inspector General.
This settlement is not the first allegation of fraud brought against American Senior Communities.
According to IndyStar, in 2016, “federal authorities accused former ASC CEO Jim Burkhart and four associates of operating a $19 million fraud scheme involving shell companies, inflated invoices and kickbacks.” This scheme, the article reports, involved Health & Hospital Corp. (HHC), which owns Indianapolis public healthcare facilities, being “overcharged on everything from medical supplies to American flags.”
Prosecutors in the 2016 suit revealed that “the men used proceeds from the fraud to fund luxurious lifestyles that included vacation homes, private planes, golf junkets and Rolex watches. All five pleaded guilty” according to the story.
Although HHC recovered most of the $19 million in damages, a special investigation by the IndyStar reported that nearly “25 people participated in nearly two dozen fraud schemes during Burkhart’s ASC tenure, resulting in fraud losses of at least $35 million.”
The news of this Medicare fraud settlement serves as a stark reminder for nursing home patients, families of patients, and everyone else that the nursing home industry is corrupted by a culture which brazenly chooses profits over patients, and chooses cover-up over accountability. In recent years, one of the nation’s largest nursing home chains and its owner agreed to pay $145 million dollars to resolve a lawsuit that the nursing home chain violated the federal False Claims Act after former employees came forward as whistleblowers.
We already know that nursing home neglect and abuse is shockingly common according to reports from patients, investigators, and even nursing home employees. Additionally, recent news has revealed that some in the nursing home industry is unlawfully pursuing debt collections from patients’ friends and family.
Whether it comes to patient care, debt collection, or Medicare fraud, it is clear that this industry has not adequately held itself accountable, and more must be done to protect the interest of nursing home residents and their loved ones.
If you have concerns about nursing home neglect or abuse, you should report it. For information about how to file a nursing home complaint, click here. By taking the time to do it, you can help make a difference.
If you suspect fraud associated with your Medicare bills, you can report fraud by calling the Inspector General’s fraud hotline at 1-800-HHS-TIPS (1-800-447-8477).
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