ATLANTA – Signature HealthCARE, LLC (“Signature”), a Louisville, Kentucky based company that owns and operates approximately 125 skilled nursing facilities, including facilities in Georgia, has agreed to resolve allegations that it violated the False Claims Act by knowingly submitting false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary, and skilled. Under the settlement agreement, Signature has agreed to pay more than $30 million.
The government’s investigation concerning Signature’s policies and practices, including whether unrealistic financial goals and scheduling therapy to achieve the highest reimbursement level regardless of the clinical needs of its patients, resulted in Signature providing and billing for unreasonable, unnecessary, and unskilled services for Medicare patients.
“Our most vulnerable citizens are put at risk when healthcare providers put their financial interests above their patients’ needs and valuable federal funds are diverted from where they are surely needed,” said U. S. Attorney Byung J. “BJay” Pak. “This settlement demonstrates our commitment to pursuing healthcare providers who provide unnecessary care to advance their bottom line.”
“Today’s settlement demonstrates our continuing efforts to protect patients and taxpayer by ensuring that the care provided to beneficiaries of government-funded healthcare programs is dictated by clinical needs, not a provider’s fiscal interests,” said Acting Assistant Attorney General Chad A. Readler for the Justice Department’s Civil Division. “Nursing home facilities provide important services to our elderly, and those facilities must uphold the trust placed in them by billing the government only for reasonable and necessary services.”
“Corporate goals should never get in the way of providing necessary quality healthcare,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “The OIG will continue to protect taxpayer dollars and vulnerable recipients of government healthcare programs.”
The message is clear, if you take advantage of programs like Medicare you will be held accountable,” said Murang Pak, Acting Special Agent in Charge of FBI Atlanta. “Companies who engage in filing false claims to generate more corporate revenue are not only stealing from the federal taxpayer, but also from people who rely on federally funded programs for their health care needs.”
The settlement resolves an investigation conducted by the U.S. Attorney’s Office for the Northern District of Georgia and allegations filed in a lawsuit by Kristi Emerson and LeeAnn Tuesca, former Signature therapy employees, in federal court in Nashville, Tennessee. The case is captioned United States ex rel. Emerson and Tuesca v. Signature HealthCARE, LLC, et al., Case No. 1:15-cv-00027 (M.D. Tenn.). The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act also allows the government to intervene and take over the action, as it did in this case. Ms. Emerson and Ms. Tuesca will receive a portion of the recovered funds.
The settlement also resolves allegations that Signature submitted forged certifications of patient need for skilled nursing care to the State of Tennessee’s Medicaid program.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.
This case was investigated by the U.S. Attorney’s Office for the Northern District of Georgia, the U.S. Attorney’s Office for the Middle District of Tennessee, the U.S. Department of Justice Civil Division’s Commercial Litigation Branch, the U.S. Department of Health & Human Services Office of Inspector General, the Federal Bureau of Investigation, and the Tennessee Bureau of Investigation.
The civil settlement was reached by Assistant U.S. Attorney Lena Amanti (Northern District of Georgia), Assistant U.S. Attorney Jason Ehrlinspiel (Middle District of Tennessee), and Christelle Klovers (Commercial Litigation Branch).