Business & Tech

$48 million Payout from Mission Viejo Nursing Home Group that 'Bilked Medicare'

The Ensign Group allegedly submitted false claims to Medicare for over 10 years.

Originally posted November 19, 2013 at 10:45 AM

A Mission Viejo-based corporation that operates nursing homes across the western United States has agreed to pay $48 million to resolve two whistleblower lawsuits over inflated Medicare bills.

Two federal lawsuits accuse The Ensign Group of submitting false Medicare claims from Jan. 1999 to Aug. 2011. The lawsuits from two former employees allege the company overcharged the government for unnecessary therapies for elderly patients, as well as therapies that were never provided.

The alleged fraud took place at six California facilities. Those facilities are:

  • Atlantic Memorial Healthcare Center, Long Beach 
  • Panorama Gardens, Panorama City
  • Orchard Post Acute Care (commonly called Royal Court), Whittier
  • Sea Cliff Healthcare Center, Huntington Beach
  • Southland, Norwalk
  • Victoria Care Center, Ventura

The suits specifically allege that EG offered improper incentives to caregivers to jack up the amount of therapy patients received for physical, occupational and speech therapy services. The therapists did so without regard to patients' needs, according to the suits.

Part of EG's incentive plan included meeting planned targets for Medicare revenue, which the company could only achieve by charging the government at the highest reimbursement levels, according to a statement from the U.S. Department of Justice.

The settlement is "one of the largest of its kind in United States history" according to United States Attorney André Birotte Jr., who said the company "regularly bilked Medicare by submitting inflated bills."

EG's central headquarters is located at 27101 Puerta Real, Suite 450.

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The lawsuits were filed under the government's qui tam whistleblower provision. If the government joins such a case, whistleblowers receive a reward of 15 percent to 25 percent of the settlement.


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