Good Samaritan Settles Improper Billing Case with United States and South Dakota
United States Attorney Brendan V. Johnson and South Dakota Attorney General Marty J. Jackley jointly announce that the United States and the State of South Dakota reached a settlement with The Evangelical Lutheran Good Samaritan Society (“Good Samaritan”) in a civil case involving health care fraud. Good Samaritan operates nursing homes in South Dakota and other states.
Good Samaritan paid $480,137 to settle allegations that it improperly billed federal and state agencies for services provided by a registered nurse who was prohibited from working for facilities receiving federal and state health care funds due to a previous criminal conviction for diverting controlled substances from patients. Following an investigation in this matter, Good Samaritan discovered it had incorrectly billed for the services of six other employees – none of whom worked in South Dakota. As a result of the additional investigation, Good Samaritan will also voluntarily return approximately $200,000.
According to the Settlement Agreement, Good Samaritan denied the allegations made by the United States and South Dakota, but settled the case without admitting liability to avoid the delay, uncertainty, inconvenience, and expense of protracted litigation.
Federal law prohibits health care facilities that receive federal or state funds such as Medicare or Medicaid from employing individuals who have been excluded from participating as providers in federal or state programs. Typically, individuals are excluded for a variety of reasons such as fraud or criminal conviction, and the exclusions are intended to protect both the public and patients. Exclusions may last for up to five years, after which an individual may apply for reinstatement. Health care facilities which receive federal or state health care funding have a duty to ensure that they do not employ excluded individuals.
“Members of the public should receive care and treatment only from those individuals who are authorized to provide it,” United States Attorney Johnson said. “Our office is grateful for the hard work and cooperation of the Health and Human Services Office of Inspector General and our state partners in the South Dakota Attorney General’s Medicaid Fraud Control Unit.”
"We are committed to strengthening our state and federal partnerships to ensure proper Medicaid disbursements," said South Dakota Attorney General Marty Jackley
Mike Fields, Special Agent in Charge of the Kansas City Regional Office for the HHS Inspector General's Office of Investigations said, "This settlement demonstrates HHS‑OIG will vigorously enforce its authority to exclude individuals from participation in federally funded healthcare programs due to previous criminal convictions."
This case was investigated by the Department of Health and Human Services Office of Inspector General and the South Dakota Attorney General’s Medicaid Fraud Control Unit. The state of South Dakota was represented by the director of its Medicaid Fraud Control Unit, Paul Cremer. The United States was represented by Assistant United States Attorney Robert Gusinsky.
CONTACT: Paige Wilbur 605.773.3215
For Immediate Release: June 23, 2010