Monthly Spotlight on Fraud, Waste, and Abuse

Why This Topic Matters

These enforcement updates highlight the compliance risks that can arise in referral relationships, medical necessity, hospice eligibility, and therapy billing. Understanding the types of allegations and resolutions covered here can help organizations stay alert to government enforcement priorities and internal audit focus areas.

Article Sections

1. Home Health Providers to Pay $4.5M to Resolve Alleged False Claims Act Liability for Providing Kickbacks to Assisted Living Facilities and Doctors

   Summarizes an alleged kickback-related settlement involving home health agencies, assisted living facilities, physicians, and Medicare referrals. The section also introduces the related fraud and abuse enforcement framework.

2. The Grand Health Care System and 12 Affiliated Skilled Nursing Facilities to Pay $21.3M for Allegedly Providing and Billing for Fraudulent Rehabilitation Therapy Services

   Covers allegations involving rehabilitation therapy billing at skilled nursing facilities and the related False Claims Act resolution. The section also notes associated federal program and oversight matters.

3. Kindred and Related Entities Agree to Pay $19.428M to Settle Federal and State False Claims Act Lawsuits Alleging Ineligible Claims for Hospice Patients

   Reviews hospice-related allegations spanning federal and state claims, whistleblower actions, and related settlement issues. The section also addresses a separate kickback allegation connected to hospice referrals.

4. Owner of Home Healthcare Company Convicted of Multimillion Dollar Healthcare Fraud Scheme

   Describes a criminal case involving home healthcare fraud, money laundering, and related misconduct allegations. The section includes the broad factual allegations and resulting conviction.

5. Santa Paula Doctor Pleads Guilty to Healthcare Fraud for Role in Hospice Scam That Bilked Medicare Out of $3.2 Million

   Summarizes a guilty plea in a hospice-related healthcare fraud matter involving Medicare billing and physician involvement. The section also mentions related co-defendant allegations and case status.

6. Precision Lens Agrees to Pay $12 Million to the United States for Kickbacks to Doctors in Violation of the False Claims Act

   Covers a civil resolution involving alleged kickbacks to physicians and resulting False Claims Act liability. The section also notes the relationship between litigation, judgment, and settlement.