On February 28, the government announced that the Texas-based skilled nursing facility, Providence Park, Inc., (DBA Ascension Living Providence Village) and acute care hospital, Ascension Providence, (FKA Providence Health Services of Waco), settled allegations that the Federal False Claims Act and the Texas Health Care Program Fraud Prevention Act were violated. The total amount paid to resolve the claims is $6,526,851.64.

According to the government’s allegations, Providence Park submitted medically unnecessary Ultra-High Resource Utilization Group therapy claims to federal healthcare programs. The US also alleged that Ascension Providence “submitted false claims to federal healthcare programs for individual outpatient therapy services at the Lacy Lakeview Clinic when group therapy was provided, and for therapy services at Woodway, Providence Sports & Physical Therapy, and Lacy Lakeview when there was no plan of care signed by a physician.”

Acting United States Attorney Margaret F. Leachman of the Western District of Texas said: “My office will hold providers accountable when they submit inaccurate claims or seek reimbursement for medically unnecessary services. I encourage providers that identify instances of improper billing to work proactively to remedy the issue, as happened in this case.”

Providence Park and Ascension Providence complied with the government’s investigation and received cooperation credit under the terms of the settlement. The company disclosed results of their internal investigation, including findings at Ascension Providence, an overpayment refund to Medicare, overpayments for outpatient therapy services, and the corrective actions to address the issues in the self-disclosure.

This settlement resolves a lawsuit filed under the qui tam or whistleblower provision of the False Claims Act, allowing private parties to file a case on behalf of the United States for a monetary portion of the government’s recovery. The amount awarded in this case has not been publicly disclosed. The lawsuit is captioned United States and Texas ex rel. Bland and Ellison v. Ascension Health Senior Care, et al., No. 5:21-CV-269 (W.D. Tex.).

Senator Chuck Grassley has historically expressed strong support for the False Claims Act, as he helped amend it in 1986 to sweeten the deal for whistleblowers. This year, Senator Grassley has called for President Trump and his appointees to embrace the key role whistleblowers play in exposing fraud and other misconduct. We are interested to see how the new administration could impact the number of False Claims Act cases filed this year.

Constantine Cannon whistleblower attorney Ginger Buck commented: “Helping the government catch and prosecute fraudsters is critical. Our firm encourages anyone with knowledge of misconduct, such as healthcare fraud, to speak up.”

If you would like to learn what it means to be a whistleblower, believe you have information relating to False Claims Act violations or healthcare fraud, please contact us so we can connect you with a member of the Constantine Cannon whistleblower lawyer team for a free and confidential consultation.

Read Texas Nursing Facility and Hospital Agree to Pay $6.5 Million to Resolve False Claims Act Allegations at constantinecannon.com