Whistleblowers Expose Healthcare Fraud
Senior Management Orchestrated Fraud
According to DUE, in a significant legal development a group of healthcare providers including the Grand Health Care System and affiliated skilled nursing facilities under Strauss Ventures LLC has been ordered to pay $21.3 million due to fraudulent medical services and billing practices. This resolution follows a whistleblower lawsuit filed under the False Claims Act by former therapy practitioners Stacey Rosenberger and Kelley Retig. Their allegations exposed extensive misconduct within the organization accusing The Grand of knowingly submitting false claims for rehabilitation therapy under Medicare Part A and TRICARE. These claims allegedly inflated the level and necessity of services provided to patients leading to unwarranted financial gains.
The investigation uncovered that senior management at The Grand orchestrated these fraudulent practices to meet financial targets and quotas. Employees were reportedly pressured to provide unnecessary and prolonged care including falsifying therapy records and submitting claims for services that were never actually provided. These actions not only compromised patient care but also defrauded government healthcare programs intended to support vulnerable populations in need of legitimate medical assistance.
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$21.3M Penalty: Grand Health Care System Cracks Under Whistleblower Exposé of Fraudulent Billing Practices! (PHOTO: Nasdaq)
Commitment to Compliance and Oversight
In response to the settlement The Grand has accepted responsibility for its actions and entered into a thorough Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General. This agreement mandates stringent oversight to ensure compliance with Medicare and TRICARE regulations over the next five years. The case underscores persistent concerns regarding the integrity of healthcare billing practices and underscores the crucial role whistleblowers play in exposing and addressing fraud within the industry. It serves as a reminder of the importance of transparency and accountability in healthcare services provided to patients nationwide.
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