From NASGA – more convictions on Medicare fraud–$50 million and $10 million

Genesis reaches $52.7 million settlement with Department of Justice

Genesis Healthcare will pay $52.7 million under an “agreement in principle” to settle four separate U.S. Department of Justice investigations, the nation’s largest long-term care company said.

The settlement will resolve allegations over inadequate staffing numbers at several of the provider’s long-term care facilities from 2005 through 2013, along with allegations of billing fraud for hospice services, according to a statement released by the company. The settlement covers alleged Medicare rule violations for physical therapy at two subsidiaries owned by Genesis.

“The company has agreed to the settlement in principle in order to resolve the allegations underlying these successor matters and to avoid the uncertainty and expense of litigation,” the company’s statement said.

Genesis said it has already set aside $39.1 million for the settlement, but it expects to record an additional loss contingency expense of $13.6 million in the second quarter of 2016 as a result of the lawsuits. They added that they plan to pay the full amount over a period of five years.

The provider currently operates nursing homes in 34 states and employs nearly 90,000 workers nationwide.



Doctors convicted in $8.8 million Medicare hospice fraud

Two California doctors were convicted Thursday (May 8, 2016) of lying about patients’ terminally ill status in order to refer them to a hospice facility and submit roughly $8.8 million in fraudulent Medicare and Medi-Cal claims.

Sri Wijegoonaratna, 61, and Boyao Huang, M.D. 43, are the sixth defendants named in the case; four other defendants have pleaded guilty to healthcare fraud and are awaiting sentencing, according to the U.S. Attorney’s Office for the Central District of California. The scheme was ran from March 2009 to June 2013.

The two physicians were convicted on charges that they falsely stated that patients were terminally ill, even if they did not require end-of-life care. The patients were then referred to California Hospice Care in Covina, CA.

“CHC nurses performed ‘assessments’ to determine whether the beneficiaries were terminally ill and, regardless of the outcome, Wijegoonaratna and Huang certified that the beneficiaries were terminally ill — even though the vast majority of them were not dying,” the attorney’s office said in a press release.

CHC submitted nearly $8.8 million in false claims to Medicare and Medi-Cal, the state’s Medicaid program, and received close to $7.4 million in payments. In exchange for their referrals to CHC, Wijegoonaratna and Huang received tens of thousands of dollars in kickbacks.

Wijegoonaratna was found guilty of seven counts of healthcare fraud, and faces a maximum of 70 years in federal prison. His medical license was revoked earlier this year. Huang was found guilty of four counts of healthcare fraud, and could serve up to 40 years in federal prison.


1 thought on “From NASGA – more convictions on Medicare fraud–$50 million and $10 million

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s