A settlement has been reached in a skilled nursing facility fraud case which alleged fraudulent Medicare and Medicaid billing practices.

Preferred Care Inc., Stanton Nursing, and Rehabilitation Center, Preferred Care Partners Management Group, owner Thomas D. Scott, and other entities have agreed to settle a lawsuit against them for $540,000. The settlement claimed that the nursing center had committed skilled nursing facility fraud by wrongfully billing Medicare and Medicaid for services.

In the skilled nursing facility fraud lawsuit, the United States government claimed that the nursing facility entities had submitted false claims to Medicare and Medicaid. Between July 2012 and October 2017, the facilities reportedly billed for higher levels of skilled nursing care than was actually needed or administered.

Additional claims were included in the complaint, alleging that patients at Stanton Nursing received substandard or worthless services. The newly proposed settlement will resolve both claims brought in the skilled nursing facility fraud lawsuit.

Numerous government officials have made positive statements about the settlement, citing it as an example of the government’s dedication to the healthcare system. Skilled nursing facility fraud does not only harm the defrauded federal government, it also jeopardizes the quality of care received by patients.

“The United States is committed to protecting our senior community by ensuring that taxpayer dollars are not misspent and nursing facility residents are receiving appropriate high-quality care,” said U.S. Attorney for the Eastern District of Kentucky Robert M. Duncan in a press release.  “This settlement, reached in cooperation with our partners at the Kentucky Attorney General’s Office of Medicaid Fraud and Abuse, highlights our efforts to combat healthcare fraud, waste, and abuse, and hold accountable those who fraudulently deprive government health care programs of vital resources.”

One official noted this and other similar settlements can help hold healthcare facilities accountable.

“Protecting the health and safety of Medicare and Medicaid patients is our top priority,” said Derrick L. Jackson, the Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “Settlements like this one hold skilled nursing facilities responsible for providing the best possible care to our beneficiaries.”

Kentucky’s Attorney General Andy Beshear remarked on the settlement’s significance in the nursing home neglect problem affecting senior citizens.

“My office works every day to protect Kentucky’s most vulnerable citizens and to seek justice for our seniors who have been physically abused,” Beshear said.  “Our work on this case is an example of our ongoing commitment and the commitment of our federal partners to stop those who harm our seniors by not giving them the very best care and service.”

The skilled nursing facility fraud lawsuit was originally brought by former employees Susan H and Joseph D. Under the qui tam provision of the False Claims Act, they may receive a portion of the federal recovery as a reward for bringing the issue to the government’s attention.

When a whistleblower lawsuit is filed, the government can choose to intervene and take over the claims, and recovery can benefit both the government and the plaintiffs. This provision incentivizes employees to report fraudulent behavior and hold their employers accountable for illegal actions.