Thanks to the work of a whistleblower, the U.S. Department of Justice recently settled with an Indiana-based skilled nursing and long-term care services company for $5.5 million to resolve allegations that it violated the False Claims Act.
A former American Senior Communities (ASC) employee filed a whistleblower lawsuit in 2017 alleging that that ASC was charging Medicare directly for various therapy services provided to beneficiaries who had been placed on hospice, when those services should have already been covered by the beneficiaries’ Medicare hospice coverage. Hospice benefits are already included in Medicare Part A as long as the patient is treated at a Medicare-certified hospice. So, in this case Medicare was being billed twice for the same services. The estimated loss to the Medicare program was $2.8 million.
In 2016, four people, including the company’s CEO and COO were indicted on 32 counts for their roles in a vast fraud, kickback, and money laundering scheme involving the nursing home chain. They were alleged to have pocketed millions in kickbacks and fraudulent overcharges, which they allegedly spent on vacation homes, private plane flights, golf trips, expensive jewelry, gold bullion, and casino chips.
In 2018, CEO James Burkhart was sentenced to 9½ years in prison after pleading guilty to three federal felony offenses, including conspiracy to commit fraud, conspiracy to violate the healthcare anti-kickback statute, and money laundering. In 2021, a federal judge denied a motion to throw out his felony fraud convictions.
Also in 2018, COO Daniel Benson was sentenced to 4½ years after reaching a plea deal.
Burkhart’s friend and associate Steven Ganote, described by prosecutors as the “bagman,” was sentenced to five years for his role after pleading guilty to conspiracy to commit mail, wire and health care fraud; conspiracy to violate the anti-kickback statute; and money laundering.
Burkhart’s brother Joshua Burkhart plead guilty to one felony count of conspiracy to commit mail, wire and healthcare fraud and to cooperate with the investigation. In return, prosecutors agreed to drop three other felony counts.
In addition to the criminal charges, the former executives were the target of a civil lawsuit filed by American Senior Communities over the embezzlement allegations.
The Health Law Offices of Anthony C. Vitale is known for its representation of whistleblowers, as well as its ability to defend those who become the target of a whistleblower action. Call 305-358-4500 or email [email protected].