In the Courts: Chain to Pay $38M in DOJ’s Largest Failure-of-Care Settlement

November 7, 2014 | Aging Services Risk Management


The U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services' Office of Inspector General (OIG) have jointly announced that a long-term and postacute care chain and its subsidiary therapy provider have agreed to pay $38 million to the federal government and eight states to resolve allegations that the chain billed Medicare and Medicaid for nursing services that were so deficient that they were effectively worthless and for medically unreasonable and unnecessary rehabilitation therapy services.

The settlement resolves allegations that between 2007 and 2013, the company billed for substandard nursing services and failed to provide care that met federal and state standards and regulatory requirements in 33 of its skilled nursing facilities in eight states. The government alleges, for example, that the company failed to have a sufficient number of skilled nurses to provide adequate care, provide adequate catheter care to some patients and residents, and follow appropriate protocols to prevent pressure ulcers and falls. The eight states involved in this part of the settlement...

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