The Department of Justice has announced that the Ensign Group, Inc. (Ensign), which operates skilled nursing facilities (SNFs) across the western United States, has agreed to pay $48 million to resolve allegations that the company systematically defrauded the Medicare program by submitting bills for unnecessary therapy services.
Under the Medicare skilled nursing benefit, Medicare patients who experience a qualifying hospital stay (of three days or more) are eligible to receive up to 100 days of skilled nursing care, including rehabilitative therapy. SNFs bill the Medicare program for providing this care. In this case, however, the DoJ alleged that Ensign fraudulently billed the Untied States for therapy that was not medically necessary or was provided to patients who did not properly qualify for the SNF benefit. Fraudblawg and Frohsin & Barger have reported previously on the prevalence of SNF fraud in the Medicare system.
Two whistleblowers who filed qui tam False Claims Act cases against Ensign will receive awards as part of the settlement, in an amount yet to be determined.
Frohsin & Barger represent whistleblowers in FCA cases across the nation and have successfully prosecuted skilled nursing fraud cases. To report skilled nursing or SNF fraud and learn your rights under the False Claims Act, contact Frohsin & Barger.