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Ensign Group Pays $48 Million To Settle Whistleblower Lawsuits Alleging Medicare Billing Fraud

LOS ANGELES, Nov. 19, 2013 /PRNewswire/ -- A whistleblower lawsuit brought by Phillips & Cohen LLP was the primary basis for a $48 million settlement the federal government announced today with the Ensign Group involving Medicare billing fraud.

The "qui tam" (whistleblower) lawsuit alleged skilled nursing facilities operated by Ensign subsidiaries were billing Medicare for treatment of patients that wasn't actually provided or wasn't medically necessary. The government also alleged that some patients were admitted for treatment at the nursing homes when they didn't need to be and that some were kept in the facilities longer than was medically necessary.

"The culture of the company emphasized profits over compliance and patient needs," said Larry P. Zoglin, a San Francisco whistleblower attorney who is Of Counsel with Phillips & Cohen ( www.phillipsandcohen.com).

Each facility administrator was required by company management to set what were called "Big Hairy Audacious Goals" for the number of Medicare patients and the amount of Medicare reimbursement per day, according to the whistleblower complaint. When goals were reached, administrators were rewarded with benefits such as all-expense paid trips to Hawaii, Alaska and other vacation spots.

"The goals that administrators were required to set were 'audacious' -- not because they were overly optimistic but because the company was pressuring administrators to achieve goals that realistically could be met only by cheating Medicare," attorney Zoglin said.

One way that managers met their "audacious" goals was to offer incentives to rehabilitation therapists and others to achieve high Medicare revenue targets, which the therapists could do only by billing at higher rates than was justified or by extending rehab therapy for longer periods than the patients needed, according to the settlement agreement.

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