Los Angeles, California – On 13th July 2020, the Justice Department reported that Longwood Management Corporation and twenty-seven affiliated skilled nursing facilities (Longwood) have assented to settle accusations that they breached the False Claim Statute by submitting fraudulent and false claims to the Medicare program for rehabilitation therapy services that were unnecessary or not reasonable. Longwood’s headquarters is in Los Angeles, and the twenty-seven skilled nursing facilities are situated in Southern California.
Nick Hanna, United States Attorney, stated that Longwood’s business plan called for large revenue from the Medicare program, and it coerced therapists to offer additional unnecessary services when targets were not attained. U.S. Attorney Hanna further said that this case shows whistleblowers’ power to shine a light on unprofessional business practices and acquire significant recoveries on behalf of U.S. taxpayers.
Ethan P. Davis, Assistant Acting Attorney General for the Justice Department’s Civil Division, stated that this settlement agreement shows the Department’s continuing dedication and commitment to ensure that patients are obtaining personalized health care services fitting to their specified medical requirements. Acting Assistant Attorney Davis further added that they would trace and hold accountable skilled nurse facilities offering rehabilitation therapy services based on maximizing profits and incomes instead of considering their patients’ interests.
The settlement agreement settled accusations that Longwood submitted false and fraudulent claims for rehabilitation therapy by engaging in a systematic effort to alter and increase Medicare billings. Medicare program pays skilled nursing facilities at a daily rate that reflects the skilled nursing and therapy needs of eligible patients. The greater the needs of the patients, the higher the rate of Medicare program payment. The highest Medicare program payment rates for skilled nursing facilities is for Ultra High therapy patients who need a minimum of twelve hours of skilled therapy from 2 therapy disciplines (for example, occupational, physical, or speech therapy), one of which has to be offered 5 days a week.
Longwood purportedly knowingly caused or submitted the submission of fraudulent and deceitful claims to the Medicare program for medically unnecessary and unreasonable Ultra High levels of rehabilitation therapy for Medicare Part A residents. Precisely, Longwood purportedly coerced therapists to increase the amount of therapy offered to patients to attain pre-planned targets for Medicare proceeds. The pre-planned targets were purported to have been set without considering patients’ personal therapy requirements. They could only be attained by charging for a high percentage of patients at the Ultra High level.
The settlement agreement covers actions that happened from 1st May 2008 through to 1st August 2012 at six facilities: Magnolia Gardens Convalescent Hospital in Granada Hills, Burbank Rehabilitation Center, Alameda Care Center in Burbank, Sherman Oaks Health & Rehab Center, Montrose Healthcare Center, and West Hills Health & Rehab Center.
The settlement agreement also covers actions that happened from 1st January 2006 through to 10th October 2014 at twenty one facilities: Chino Valley Rehabilitation Center LLC, Burlington Convalescent Hospital in the Westlake District of Los Angeles, Covina Rehabilitation Center, Colonial Care Center in Long Beach, Green Acres Lodge in Rosemead, Crenshaw Nursing Home, Imperial Crest Health Care Center in Hawthorne, Imperial Care Center in Studio City, Live Oak Rehabilitation Center in San Gabriel, Laurel Convalescent Hospital in Fontana, Monterey Care Center in Rosemead, Longwood Manor Convalescent Hospital in the Mid-City District of Los Angeles, Park Anaheim Healthcare Center, Intercommunity Healthcare Center in Norwalk, San Gabriel Convalescent Center, Pico Rivera Healthcare Center, Studio City Rehabilitation Center, Whittier Pacific Care Center, View Park Convalescent Center in Baldwin Hills, Sunnyview Care Center in the Pico-Union District of Los Angeles, and Western Convalescent Hospital in the Jefferson Park District of Los Angeles.
Simultaneous with the civil settlement agreement, Longwood has kicked off a 5-year Corporate Integrity Agreement with the United States Health and Human Services Department – Office of the Inspector General that needs an independent review organization to yearly assess the Medical appropriateness and necessity of therapy services charged to Medicare Program.
Special Agent in Charge Timothy B. DeFrancesca for the United States Health and Human Services Department – Office of the Inspector General stated that the federal government was placated that Longwood deceitfully and fraudulently claimed medically unnecessary and unreasonable level of rehabilitation services at the expense of taxpayers. Special Agent in Charge DeFrancesca further said that his agency’s compliance agreement was designed to monitor claims to Medicare and stop the submission of false and fraudulent claims to Medicare programs in the future.
The settlement agreement partially settles accusations submitted in two cases lodged by Whistleblowers under the qui tam provisions of the False Claims Statute, which permits private parties to submit suit on behalf of the U.S. government and to get a percentage share in any recovery obtained. Benjamin Monsod, Judy Boyce, and Keith Pennetti, the whistleblowers, will collectively obtain 3,006,000 USD of the settlement returns.
The settlement agreement was the outcome of a synchronized and coordinated work and effort by the Civil Division of the Department of Justice, the U.S. Attorney’s Office for the Central District of California (U.S. Assistant Attorney John Lee of the Civil Fraud Section), the United States Health and Human Services Department – Office of the Inspector General, the United States Attorney’s Office for the Northern District of Alabama, and the Defense Criminal Investigative Service.
The lawsuits are captioned United States ex rel. Boyce, Judy and Monsod, Benjamin v. Aegis Therapies, Inc., GGNSC Holdings LLC, and Longwood Management Corp., CV16-8050 (C.D. Cal.), and United States ex rel. Pennetti v. Longwood Management Corp. et al., CV14-4133 (C.D. Cal.). The claims settled by this settlement agreement are just accusations, and there has been no liability determination.
Individuals who collude or commit Medicaid or Medicare Fraud conspiracies or break the False Claim Statute break the law. Committing or Colluding to execute Medicaid or Medicare Fraud conspiracies is a serious criminal activity. Any person or medical practitioner who defraud or schemes to execute Medicaid or Medicare Fraud conspiracies is severely penalized or punished if found guilty and responsible for the criminal action. If charged for defrauding Medicaid or Medicare or violating the False Claim Act, you must seek legal assistance or representation to pursue and protect your rights. If you receive the most acceptable legal representation, advice, or assistance, you get positive results in your case. Hire us immediately if you want the most excellent legal representation, advice, or assistance to achieve positive results in your case. Health Care Fraud Group has a highly trained team of skilled criminal attorneys and health care fraud defense attorneys with excellent experience and matchless case win history. The team is highly conversant and understands the need to prove innocence after the indictment of any offense, like any of the crimes mentioned above. Call us now or anytime at 888-402-4054 for any legal assistance, advice, or representation you may need.
