States Attorney's Office District of Connecticut
|March 2, 2010||
HEALTH CARE FACILITIES THAT EMPLOYED “EXCLUDED PROVIDERS” SETTLE FALSE CLAIMS ACT ALLEGATIONS
Nora R. Dannehy, United States Attorney for the District of Connecticut, today announced that THE MAY INSTITUTE, a Massachusetts-based behavioral health care provider with a facility located at 360 Tolland Turnpike in Manchester, Connecticut, has entered into a civil settlement agreement with the Government in which it has agreed to pay $109,688.96 to resolve allegations that it violated the False Claims Act. The allegations against THE MAY INSTITUTE involved claims that the Manchester facility caused claims to be submitted to federal health care programs for services performed by two individuals who had been excluded from Medicare and Medicaid.
U.S. Attorney Dannehy explained that when the United States Department of Health and Human Services, Office of the Inspector General (HHS-OIG) excludes an individual or entity from federal health care programs, no program payments may be made for items or services furnished by that excluded individual or entity. In September 1999, HHS-OIG issued a Special Advisory Bulletin in order to provide guidance to health care providers who might employ or contract with an excluded individual or entity. The Special Advisory Bulletin advised that in order to avoid potential liability, health care providers should check the List of Excluded Individuals/Entities on the HHS-OIG web site. In September 2005, the Connecticut Department of Social Services issued a similar bulletin, warning providers of their responsibility to perform appropriate due diligence to ensure that payments were not being made for services provided by an excluded individual or entity.
THE MAY INSTITUTE failed to check the HHS-OIG online exclusion database before hiring the two individuals. The individuals are no longer employed by THE MAY INSTITUTE.
The settlement with THE MAY INSTITUTE is the latest of several that have been entered into as a result of the U.S. Attorney’s Office and HHS-OIG’s ongoing Excluded Provider Project. In July 2009, RELIANCE HOUSE, a behavioral healthcare provider located at 40 Broadway in Norwich, agreed to pay $5,723.34. In August 2009, GREENTREE MANOR, a skilled nursing and rehabilitation center located at 4 Greentree Drive in Waterford, agreed to pay $14,979.60. In September 2009, STONINGTON INSTITUTE, a behavioral healthcare provider located at 75 Swantown Hill Road in North Stonington, agreed to pay $21,430.54. And in January 2010, GROTON REGENCY, a skilled nursing and rehabilitation center located at 1145 Poquonnock Road in Groton, agreed to pay $42,363.16. In each of these cases, the facility agreed to resolve allegations that it violated the False Claims Act by submitting or causing to be submitted claims to federal health care programs for services performed by an individual who had been previously excluded from Medicare and Medicaid.
To resolve their liability under the False Claims Act, THE MAY INSTITUTE, RELIANCE HOUSE, GREENTREE MANOR, STONINGTON INSTITUTE, and GROTON REGENCY agreed to pay damages on the portion of the excluded individuals’ salaries attributable to federal health care programs. The False Claims Act provides for treble damages and penalties of $5,500 to $11,000 per false claim submitted to the Government. However, if the person or entity who violates the act promptly discloses the violation to the Government and fully cooperates with any Government investigation of the violation, the Government can recover only up to double damages.
THE MAY INSTITUTE, RELIANCE HOUSE, GREENTREE MANOR, and STONINGTON INSTITUTE agreed to enter into certifications promising that they have established policies and procedures to check both prospective and current employees to make sure that they have not been excluded from federal healthcare programs.
In entering into their respective civil settlement agreements, THE MAY INSTITUTE, RELIANCE HOUSE, STONINGTON INSTITUTE, GREENTREE MANOR, and GROTON REGENCY did not admit liability.
“Health care providers have no excuse for failing to perform a simple check of the HHS-OIG online exclusion database,” stated U.S. Attorney Dannehy. “The law is clear, and the Government will seek appropriate damages and penalties under the False Claims Act from health care providers that submit claims for services provided by excluded individuals.”
U.S. Attorney Dannehy noted that, to date, providers have paid the Government a total of $476,943.09 as a result of the Excluded Provider Project.
This matter is being investigated by the U.S. Department of Health and Human Services, Office of Inspector General, and is being prosecuted by Assistant United States Attorney Anne F. Thidemann, along with Auditor Kevin A. Saunders.
People who suspect health care fraud are encouraged to report it by calling the Health Care Fraud Task Force at (203) 785-9270 or 1-800-HHS-TIPS.
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