Masonic Villages of the Grand Lodge of Pennsylvania Agrees to Pay the United States $325,080 To Resolve Disputed
Medicare Claim Payments
The United States Attorney's Office for the Middle District of Pennsylvania announced that the Masonic Villages of the Grand Lodge of Free and Accepted Masons of Pennsylvania has agreed to pay the United States $325,080.90 to resolve violations of the False Claims Act, 31 U.S.C. §§ 3729-3733.
Masonic Villages is a Medicare and Medicaid provider, offering nursing care and personal living accommodations to residents at four campuses in Pennsylvania: Elizabethtown; Lafayette Hill; Sewickley; and Warminster.
According to United States Attorney Peter J. Smith, the Masonic Villages voluntarily disclosed to the government that from June 2007, through September 2010, the contractor that provided rehabilitation therapy services at the Masonic Villages' Lafayette Hill, Sewickley, and Warminster campuses did not maintain accurate daily treatment notes, as required by Medicare regulations.
Based on a review of the disclosure, the government concluded that Masonic Villages failed to follow proper Medicare coding and documentation regulations required for evaluating and billing for Medicare and Medicaid patients who may need rehabilitative therapy services. Specifically, Masonic Villages did not properly document the time spent on initial patient assessments for rehabilitative therapy services and failed to maintain accurate treatment notes for rehabilitative therapy provided on the same day as the initial assessment at Masonic Villages' Lafayette Hill, Sewickley, and Warminster campuses. In addition, Masonic Villages at Sewickley billed for individual therapy sessions at times when therapy was provided concurrently and failed to maintain adequate documentation for these services.
U.S. Attorney Smith commended the Masonic Villages for its willingness to voluntarily bring this matter—discovered during an internal audit—to the government's attention and to strengthen internal controls to ensure compliance with Medicare and Medicaid regulations in the future.
This case was investigated by the U.S. Department of Health and Human Services, Office of the Inspector General in Harrisburg. Lisa Veigel of the U.S. Department of Health and Human Services, Office of Counsel to the Inspector General, and Brian Simpson, of the United States Attorney's Office, Civil Division, handled the case.
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