Waco-based Providence Park, Inc., known as Ascension Living Providence Village, and Ascension Providence, previously Providence Health Services of Waco, are set to pay a hefty sum in a settlement with the government. In total, the organizations have agreed to cough up over $6.5 million to resolve claims of violating the Federal False Claims Act and Texas Health Care Program Fraud Prevention Act. The issue at hand revolves around allegations that the skilled nursing facility and acute care hospital submitted false claims to federal healthcare programs, including billing for medically unnecessary services.
Acting U.S. Attorney Margaret F. Leachman of the Western District of Texas did not mince words when describing the misconduct, emphasizing the importance of holding providers accountable. She stated, "My office will hold providers accountable when they submit inaccurate claims or seek reimbursement for medically unnecessary services," as reported by the U.S. Department of Justice's website. It should be noted, however, that the claims resolved by the settlement are allegations only, with no determination of liability being made.
The allegations specifically accuse Providence Park of submitting false Ultra-High Resource Utilization Group therapy claims and Ascension Providence of billing individual outpatient therapy services while apparently providing group therapy, among other transgressions. Furthermore, according to the allegations, services were billed without a physician's plan of care at several Ascension Providence facilities, showcasing a pattern of intentional or severely negligent billing practices.
Despite the severity of the accusations, both Providence Park and Ascension Providence received credit for their cooperation during the investigation. By disclosing results of an internal investigation and identifying overpayments proactively, they've demonstrated a commitment to rectifying the situation. Describing the cooperation, a statement obtained by the Justice Department highlighted these efforts, saying that both entities "cooperated with the United States’ investigation by, among other things, disclosing the results of an internal investigation at Ascension Providence that resulted in an overpayment refund to Medicare."
The lawsuit, now settled, was initially filed under the whistleblower provision of the False Claims Act, which allows private parties to sue on behalf of the U.S. government and potentially share in the recovery. This particular case, labeled United States and Texas ex rel. Bland and Ellison v. Ascension Health Senior Care, et al., NO. 5:21-CV-269, unfolded in the Western District of Texas. The Assistant United States Attorney Thomas Parnham negotiated the settlement terms for the U.S., working towards a resolution that seems aimed at preventing similar instances of fraud in the future.
