United States of America v. Caring Heart Rehabilitation and Nursing Center, et al.

Baltimore, MD - United States Reaches Settlement With Four Facilities And Two Medical Companies To Resolve Allegations Of Fraudulent Billing In Skilled Nursing Facilities



The United States Attorney’s Office announced that it reached an agreement with four skilled nursing facilities and two consulting companies with which they contracted to resolve allegations of fraudulent billing of Medicare for the provision of skilled therapy to Medicare and Tricare beneficiaries.



The civil settlement resolves a lawsuit filed under the whistleblower provisions of the False Claims Act, which permits private parties to file suit on behalf of the United States for false claims and obtain a portion of the government's recovery. The civil lawsuit was filed in the District of Maryland and is captioned United States ex rel. Tober v. Global Empire, LLC, et al., Civil No. RDB-12-2567. As part of the resolution, Mr. Tober will receive $990,000.



The United States alleged that during the period January 1, 2010 through January 31, 2014 the defendants billed Medicare for skilled therapy services that were either not delivered or that were medically unnecessary. Medicare provides a skilled nursing benefit that pays for rehabilitative skilled nursing services for a period of 100 days following a qualifying hospitalization. Medicare pays skilled nursing facilities (SNF) a set rate that depends on a number of factors such as the acuity of the patient and the level and amount of skilled therapy provided. The amount of skilled therapy is counted in minutes of therapy provided, and the United States alleged that the four SNFs and the two consulting companies falsely reported the number of minutes of skilled therapy that was delivered or that was medically necessary. Increasing the number of minutes in many instances brought the patient into a category that resulted in higher compensation for the SNF. The United States alleged that the consulting companies and the SNFs put systems in place to maximize Medicare and Tricare reimbursement and that caused the submission of claims for therapy services that were either not provided or that were unnecessary.



The claims resolved by this settlement are allegations only, and there has been no determination of liability. Caring Heart Rehabilitation and Nursing Center, GNH, LLC, OPOP, LLC, Riverview SNF, LLC, Global Healthcare Services Group, LLC and GHC Clinical Consultants, LLC have denied the allegations.

Caring Heart Rehabilitation and Nursing Center agreed to pay the United States $1,272,891.00. GNH, LLC agreed to pay $811,153.36. OPOP, LLC agreed to pay $608,365.02. Riverview SNF, LLC agreed to pay $1,206,590.62. Global Healthcare Services Group, LLC agreed to pay $190,000. GHC Clinical Consultants, LLC agreed to pay $1,810,000.00