State: Senior Care Company Made False Medicare Claims

  NEW JERSEY – A senior care company has agreed to pay $714,996 to settle allegations that it violated the False Claims Act.

  According to Attorney Rachael A. Honig, the company allegedly made false representations in connection with submissions to the Centers for Medicare & Medicaid Services.

  The settlement agreement states that CareOne Management LLC, now known as ABC1857 LLC (CareOne), had submitted claims for payment to Medicare for reimbursement of Medicare bad debt from January 1, 2012, to July 2, 2018. Medicare will reimburse health care providers for uncollectable deductible and coinsurance amounts from Medicare beneficiaries.

  According to the settlement, “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.”

  Margaret Gathman had filed a lawsuit for these allegations under the False Claims Act. The Act allows private parties to sue for false claims on behalf of the United States and to share in any recovery. Gathman will receive $143,000 from the federal share of the settlement.

  Any tips on potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 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.