Whistleblower suits arise from claims for reimbursement under Medicare, Medicaid, or TRICARE.
Three Ohio-based companies, Foundations Health Solutions Inc (FHS), Olympia Therapy Inc, and Tridia Hospice Care Inc, along with 2 company executives, Brian Colleran and Daniel Parker, will pay nearly $19.5 million to settle allegations that the companies submitted false claims for medically unnecessary rehabilitation therapy and hospice services to Medicare.
FHS provided management services to skilled nursing facilities. Olympia provided rehabilitation therapy services to patients at the skilled nursing facilities, while Tridia provided hospice care services. Colleran and Parker partially controlled or owned each of these companies (or their predecessors) between 2008 and 2013.
The false claims allegations arose via 2 separate whistleblower suits. In 2011, Vladimir Trakhter, a physical therapist and former Olympia employee, filed suit under the qui tam provisions of the False Claims Act alleging that Olympia submitted claims for medically unnecessary rehabilitation therapy services at 18 skilled-nursing facilities.
Trakhter contended that the therapy services were provided at excessive levels to increase Medicare reimbursement. In several cases, patients were injured.
In 2012, Paula Bourne and La’Tasha Goodwin likewise filed suit against Tridia for submitting false hospice care benefit claims to Medicare. They alleged that Tridia submitted claims for patients who were ineligible for the benefit because the company had failed to perform the appropriate certifications and medical examinations.
In addition, the settlement resolves allegations that Colleran and Parker solicited and received kickbacks for referring patients to Amber Home Care LLC, a provider of home health care services.
In a statement, US Attorney Benjamin C. Glassman for the Southern District of Ohio said, “It is unacceptable for an entity entrusted to care for our most vulnerable and elderly citizens to make decisions based on profit, not quality of care. Subjecting the elderly to inappropriate levels of therapy can be physically harmful, and failing to properly certify and re-certify hospice patients can have a devastating impact on patients and their families.”
In addition to the $19.5 million settlement, FHS and Colleran have entered into a 5-year Corporate Integrity Agreement (CIA) with the HHS Office of Inspector General. The whistleblowers will each collect a share of the settlement.
Trahkter will receive approximately $2.9 million, while Bourne and Goodwin will share $740,000. Compliance with the complex requirements of the nation’s federal health care programs is vital for any health care entity that submits claims for reimbursement under Medicare, Medicaid, or TRICARE.
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