North American Health Care Inc., its chairman of the board, John Sorenson, and its senior vice president of Reimbursement Analysis, Margaret Gelvezon, have agreed to pay a total of $30 million for submitting false claims to the federal government’s health care programs, federal officials announced today.
“Medicare patients and those insured by TRICARE are entitled to receive care necessary for their clinical needs and not the financial needs of their health providers,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “Health care providers will be held accountable if they bill for unnecessary services or treatment.”
The unnecessary rehabilitation therapy services were provided to residents of North American Health Care’s nursing facilities, officials said.
Under the settlement agreement, NAHC has agreed to pay $28.5 million. Mr. Sorensen has agreed to pay $1 million and Ms. Gelvezon has agreed to pay $500,000.
NAHC is a private, for-profit company headquartered in Orange County, California, that has service agreements to operate 35 nursing facilities, most of them in California. The nursing facilities provide inpatient rehabilitation services, including physical, occupational, and speech therapy, to patients, according to authorities.
Gelvezon contributed to this conduct by creating the improper billing scheme. The government also contends that Sorensen, in his capacity as chairman of the board of Health Care, reinforced this scheme at the facilities.
The illegal billing occurred during the period from Jan. 21, 2005, to Oct. 31, 2009, for all of the nursing facilities, and continued during the period of Nov. 1, 2009, to Dec. 3, 2011, for three of the facilities in the northern California area.
“This office is committed to safeguarding the federal health care programs and the patients who are enrolled in them,” said U.S. Attorney Brian J. Stretch for the Northern District of California. “Skilled nursing facilities such as NAHC treat some of the most vulnerable patients in the health care system. These facilities, and the individuals who run them, will be held accountable when they provide treatment based on financial motivations instead of the patients’ needs.”
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