In a recent legal resolution, Providence Park, Inc., operating as Ascension Living Providence Village, and Ascension Providence, formerly known as Providence Health Services of Waco, have agreed to pay $6.5 million to settle allegations under the Federal False Claims Act and the Texas Health Care Program Fraud Prevention Act. This case stems from the submission of false claims to federal healthcare programs, including medically unnecessary therapy services at a skilled nursing facility and improper outpatient therapy services at an acute care hospital.
Allegations of Fraudulent Practices
The U.S. government alleged that Providence Park, which runs a skilled nursing facility in Waco, submitted fraudulent claims for unnecessary therapy services. These claims were categorized as Ultra-High Resource Utilization Group therapy, which is only reimbursed by federal healthcare programs under specific conditions. Meanwhile, Ascension Providence allegedly submitted false claims for outpatient therapy services, where group therapy was billed as individual therapy, and therapy services were provided without a signed physician’s care plan.
Settlement Details and Cooperation
The settlement amount of $6,526,851.64 is intended to resolve these allegations without a determination of liability. Providence Park and Ascension Providence cooperated with the investigation, resulting in corrective actions and refunds to Medicare for the overpayments related to the improper therapy services. This case was filed under the qui tam, or whistleblower provision, of the False Claims Act, allowing private individuals to report fraudulent activity on behalf of the government.
The Importance of Whistleblowers in Fighting Fraud
This settlement highlights the vital role whistleblowers play in uncovering fraud in healthcare systems. Whistleblowers who identify and report such fraudulent practices not only help to recover misused taxpayer funds but also protect the integrity of health programs serving vulnerable populations. Without the assistance of whistleblowers, many fraudulent schemes could go unnoticed, costing both the public and the healthcare system billions of dollars.
If you are aware of fraudulent activities similar to those outlined above, or any other type of misconduct, you can help by coming forward as a whistleblower. The Whistleblower Advocates team in Philadelphia offer free and confidential consultations to guide you through the legal process. Our team is dedicated to protecting your rights and ensuring that those responsible for defrauding the government are held accountable.
This article is a news article for informational purposes only. The Whistleblower Advocates did not represent the parties identified in the story above.
