Pa. Medicaid to get $2.2 million in health care fraud settlement with nursing facilities operator Extendicare
Attorney General Kathleen G. Kane today announced that Pennsylvania, seven states and the federal government have reached an agreement with Extendicare Health Services Inc. (Extendicare) and its subsidiary Progressive Step Corporation (ProStep) to settle allegations that Extendicare billed Medicare and Medicaid for substandard nursing services in 33 nursing facilities, five of which are in Pennsylvania.
As a result of today’s settlement, the Department of Justice and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) will receive $32.3 million; the state Medicaid programs will receive $5.7 million.
The settlement is the largest failure-of-care settlement with a chain-wide skilled nursing facility in DOJ’s history.
Pennsylvania’s Medicaid program will receive a total of $2.2 million that will be divided between the state and the federal government. Of that amount, the Commonwealth will keep $970,260.
The settlement resolves allegations that between 2007 and 2013, Extendicare committed health care fraud for materially substandard skilled nursing services and failed to provide care to its residents that met federal and state standards of care and regulatory requirements.
The government alleges that Extendicare failed to: have a sufficient number of skilled nurses to adequately care for its skilled nursing residents; provide adequate catheter care to some of the residents; and follow the appropriate protocols to prevent pressure ulcers or falls.
In addition, Extendicare entered into a five-year, multistate Corporate Integrity Agreement with HHS-OIG, which mandates that the company retain an independent monitor who will report whether adequate conditions and staffing levels are being maintained.
Representatives from the Office of Attorney General, who are on the National Association of Medicaid Fraud Control Units team, participated in the investigation and conducted the settlement negotiations with Extendicare.
Also included in the settlement are Indiana, Kentucky, Michigan, Minnesota, Ohio, Washington and Wisconsin.
Based in Delaware, Extendicare operates 146 skilled nursing facilities in 11 states. ProStep provides physical, speech, and occupational rehabilitation services.