A Sandy Springs-based business has agreed to pay millions to resolve accusations it violated the False Claims Act regarding how it billed Medicare and Medicaid during a four-year period.

According to a news release, SavaSeniorCare LLC agreed to pay $11.2 million, plus more funds if certain financial contingencies occur, to resolve allegations it violated the False Claims Act by “causing its skilled nursing facilities to bill the Medicare program for rehabilitation therapy services that were not reasonable, necessary or skilled, and to resolve allegations that Sava billed the Medicare and Medicaid programs for grossly substandard skilled nursing services.”

Sava owns and operates these facilities across the United States, and the settlement was based on the company’s ability to pay.

“Nursing home operators will be held accountable when they engage in fraudulent schemes and put their own financial gain ahead of the needs of their vulnerable residents,” Brian M. Boynton, acting assistant attorney general of the Justice Department’s civil division, said in the release. “To ensure the integrity of our public health care programs, the department will pursue operators who bill Medicare and Medicaid for unnecessary or grossly substandard services and who fail to provide adequate care.”

In 2015, the government filed a consolidated False Claims Act complaint against Sava, alleging that between October 2008 and September 2012, the company knowingly submitted false claims for rehabilitation therapy services as a result of a systematic effort to increase its Medicare billings.

The United States’ complaint alleged that, through corporate-wide policies and practices, Sava exerted significant pressure on its facilities to meet unrealistic financial goals, resulting in the provision of medically unreasonable, unnecessary or unskilled services to Medicare patients.

“Sava allegedly set these aggressive, prospective corporate targets for the highest Medicare reimbursement rates without regard for its patients’ actual clinical needs and then pressured its staff to meet those targets,” the release stated. “Sava also allegedly sought to increase its Medicare payments by delaying the discharge of patients from its facilities, even though the patients were medically ready to be discharged.”

In addition, this settlement resolves allegations that between January 2008 and December 2018, Sava knowingly submitted false claims for payment to Medicare and Medicaid for grossly and materially substandard and/or worthless skilled nursing services

The government alleged that some of the nursing services provided by Sava failed to meet federal standards of care and federal statutory and regulatory requirements, including failing to have sufficient staffing in certain facilities to meet certain residents’ needs.

The government also alleged that in certain facilities, Sava failed to follow appropriate pressure ulcer protocols and appropriate falls protocols, and failed to appropriately administer medications to some of the residents.

In connection with the settlement, Sava entered into a five-year chain-wide corporate integrity agreement with the U.S. Department of Health and Human Services Office of Inspector General that requires an independent review organization to annually review patient stays and associated paid claims by Medicare for those stays.

In addition, Sava is required to engage an independent monitor to review the quality of resident care. corporate integrity agreements promote compliance and protect vulnerable nursing home residents.

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act against Sava by Realtors Rita Hayward, Trammel Kukoyi, Terrence Scott, James Thornton and Barbara Roberts. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery.

Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to Health and Human Services at 800-447-8477.

An email message sent to a Sava spokesperson seeking comment on the agreement was not returned by the Neighbor’s deadline.

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