NEWARK, N.J. – A New Jersey senior care company will pay $714,996 to resolve allegations that it violated the False Claims Act by making false representations in connection with submissions to the Centers for Medicare & Medicaid Services, Acting U.S. Attorney Rachael A. Honig announced today.
According to the contentions of the United States contained in the settlement agreement:
CareOne Management LLC, now known as ABC1857 LLC (CareOne), submitted claims for payment to Medicare for reimbursement of Medicare bad debt from Jan. 1, 2012, to July 2, 2018. Medicare reimburses health care providers for uncollectable deductible and coinsurance amounts from Medicare beneficiaries – known as “bad debts.” The company made false representations of compliance with applicable statutory and regulatory criteria, including “criteria for allowable bad debt,” which require a provider to “be able to establish that reasonable collection efforts were made” of amounts owed by beneficiaries before a provider submits the claim as bad debt to Medicare.
The allegations were originally made in a lawsuit filed by Margaret Gathman under the whistleblower provisions of the False Claims Act. The Act permits private parties to sue for false claims on behalf of the United States and to share in any recovery. Ms. Gathman will receive $143,000 from the federal share of the settlement.
Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800‑HHS‑TIPS (800-447-8477).
Acting U.S. Attorney Honig credited special agents of the FBI, under the direction of Special Agent in Charge George M. Crouch Jr. in Newark; special agents of the U.S. Department of Health and Human Services, Office of the Inspector General, under the direction of Special Agent in Charge Scott J. Lampert; and special agents of the U.S. Attorney’s Office for the District of New Jersey, under the direction of Supervisory Special Agent Thomas Mahoney, with the investigation leading to the settlement.
The government is represented by Assistant U.S. Attorney Daniel Meyler of the Health Care Fraud Unit in Newark.
The lawsuit is captioned United States ex rel. Gathman v. CareOne LLC, 17-cv-6180 (D.N.J.). The claims settled by this agreement are allegations only, and there has been no determination of liability.