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From Health Law Daily, July 25, 2016

DOJ charges three in $1B fraud case, largest ever against individuals

By Bryant Storm, J.D.

The Department of Justice (DOJ) charged three individuals—the owner of several skilled nursing and assisted living facilities, a hospital administrator, and a physician’s assistant—for their roles in a $1 billion scheme to defraud Medicare and Medicaid. According to the charges, patients were admitted to facilities through a scheme of bribes and kickbacks, where they were given medically unnecessary or harmful treatments. According to an announcement by Assistant Attorney General Leslie R. Caldwell, the case is "the largest single criminal health care fraud case ever brought against individuals by the DOJ."

Fraud. The indictment asserts that the owner of the facilities, in concert with the two other individuals, admitted Medicare and Medicaid beneficiaries for skilled nursing or assisted living care despite the fact that the services those beneficiaries received were medically unnecessary. The charging documents allege a disregard for patient safety, including allegations that drug addicts were prescribed opioids and other narcotics in order to entice them to stay in a facility in which they did not belong.

Kickbacks. The conspirators allegedly paid bribes and kickbacks to get patients admitted to the owner’s facilities. In circumstances where Medicare imposed length of stay limits at one facility, the conspirators relied on bribes, kickbacks, and a network of providers to move patients between different facilities. The conspirators allegedly paid kickbacks in cash or disguised them as charitable contributions to avoid detection by law enforcement. The indictment also alleges that one of the individuals laundered money through sham medical director contracts.

Prior misconduct. According to the court documents, the owner of the facilities paid $15.4 million in 2006 to resolve civil federal health care fraud claims resulting from similar fraudulent conduct.

Companies: Adar Associates/Dvar Tove, LLC; ADME Investment Partners LTD dba Oceanside Extended Care; Adirhu Associates LLC; Almovea Associates LLC dba North Dade Nursing and Rehabilitation Center; Ayintove Associates LLC dba Harmony Health Center; Courtyard Manor Retirement Living, Inc.; Eden Gardens LLC; Fair Havens Holding LLC/Fair Havens Center LLC; Flamingo Park Manor LLC/The Pointe; La Covadonga Retirement Living, Inc.; Lake Erswin LLC dba South Hialeah Manor/Interamerican; Kabirhu Associates LLC dba Golden Glades Nursing and Rehabilitation Center; Lauderhill Manor LLC; La Serena Retirement Living LLC/La Hacienda Gardens/Rainbow; Jene's Retirement Living, Inc./Jene's Retirement Investors Ltd dba North Miami Retirement Living; Sefardik Associates, LLC dba The Nursing Center at Mercy; Takifhu Associates LLC dba South Dade Nursing and Rehabilitation Center; Williamsburg Retirement Living

MainStory: TopStory NewsStory AgencyNews ReimbursementNews ComplianceNews CMSNews BillingNews FraudNews PaymentNews ProgramIntegrityNews QualityNews SafetyNews SNFNews

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