INDIANAPOLIS — The U.S. Department of Justice (DOJ) says American Senior Communities, L.L.C. (ASC) has agreed to pay $5,591,044.66 to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program.
The claims are allegations only and there has been no determination of liability, according to the DOJ. ASC has denied all liability under the False Claims Act.
In 2017, a former employee of a hospice services company doing business with ASC filed a sealed civil complaint alleging ASC was charging Medicare directly for various therapy services provided to beneficiaries who had been placed on hospice, when those services should have already been covered by the beneficiaries’ Medicare hospice coverage.
Based on the investigation, the estimated loss to the Medicare program was $2,795,522.33 and ASC has agreed to pay $5,591,044.66 to the United States.
“Whistleblowers are critical to protecting public funds from fraud, waste, and abuse,” said U.S. Attorney Zachary A. Myers. “Health care providers who submit false claims or otherwise violate state and federal regulations when billing the United States Government will face consequences. Today’s settlement demonstrates that federal law enforcement agencies will vigorously investigate reports of false claims and seek to recover funds on behalf of the public.”
ASC released the following statement to WRTV Wednesday:
"In July 2022, ASC entered into a settlement agreement with the United States government and a qui tam relator to resolve a lawsuit seeking relief under the False Claims Act for ASC’s alleged improper billing for therapy services to hospice patients. ASC denies liability for the allegations in the complaint, which relate to only a narrow set of services ASC provides to residents, and importantly do not suggest any impropriety with respect to quality of care or patient harm. ASC has implemented a number of measures to enhance its billing procedures to protect against conduct of the kind alleged in the suit. ASC is pleased to resolve this legacy matter relating to conduct that was alleged to have initiated under its prior management team."
The Department of Health and Human Services – Office of the Inspector General did not uncover any evidence of injury or harm to patients because of the alleged conduct.
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