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March 20, 2013 Healthcare Fraud

False Claims Act Lawsuit Forces Golden Living to Settle Claims of Fraudulent Wound Care

The United States and the State of Georgia recently reached a settlement in a False Claims Act lawsuit with Golden Gate National Senior Care (GGNSC). While headquartered in the state of Texas, Golden Gate National Senior Care operates skilled nursing facilities across the nation under the “Golden Living” brand, including facilities in Atlanta, Georgia. The government alleges GGNSC provided poor and fraudulent wound care services to residents at two of its Atlanta area nursing homes. GGNSC agreed to pay $613,300 to settle a whistleblower case filed under the federal False Claims Act and the Georgia State False Medicaid Claims Act .

The complaint filed in the federal and state False Claims Act case includes allegations regarding patients who were receiving wound care treatment at two GGNSC skilled nursing facilities in Atlanta between the years of 2006 and 2011. The government (and whistleblower) alleges that GGNSC knowingly and willingly submitted false claims to Medicaid, Medicare and the Veterans Administration by providing residents at Golden Living Center–Glenwood and Golden Living Center–Dunwoody (formerly known as Golden Living Center–Northside) with inadequate and worthless monitoring, documentation, prevention and treatment of wounds from January 1, 2006 through May 31, 2011. By submitting fraudulent claims to the government, GGNSC violated both the federal False Claims Act and the Georgia False Medicaid Claims Act.

The Case Whistleblower

The case was originally filed under seal by whistleblower Dr. Joseph L. Micca, medical director of the Atlanta, Georgia Golden Living Facility. Dr. Micca’s complaint gave gruesome details of the living conditions at the facility, including those of wound patients suffering terrible neglect. The civil settlement resolves some of the claims in a lawsuit filed by Dr. Joseph L. Micca under the qui tam or “whistleblower” provisions of the False Claims Act.  The qui tam provisions allow private citizens to sue on behalf of the United States government and share in any monetary recovery the government receives.  More specifically, the qui tam provisions of the False Claims Act require that whistleblowers receive a reward between 15 and 30 percent of the total amount recovered by the government. As a reward for helping the government put a stop healthcare fraud, Dr. Micca will receive a share of the settlement payment that resolves certain claims in the qui tam suit that he initially filed.

Government will Continue Investigating Medicare Fraud Cases

According to Georgia Attorney General Sam Olens, ”Golden Living fraudulently billed Medicaid for nursing services which were substandard and, tragically, resulted in harm to patients. The nursing home patients depended on Golden Living to provide them with quality wound care services to help them heal, but, instead, were mistreated. We will not stand for such egregious misconduct by a Medicaid provider.”

“Our office is committed to protecting our most vulnerable citizens and improving the lives of nursing home residents,” said Sally Quillian Yates, United States Attorney for the Northern District of Georgia. “By failing to provide adequate wound care services to its nursing home residents, Golden Living placed at risk the life and health of individuals who were entrusted to its care. This type of threat to the health and well-being of the elderly in our communities will not be tolerated.”

Quality of care in nursing homes is a top priority for the Office of Inspector General,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Atlanta region. “Health care providers need to know that if they provide worthless services to those most in need, they will pay the price.”

GGNSC expressly denied all allegations of physical harm, saying no residents experienced a decline in health and that the allegations were “untested.” The terms of this settlement involve GGNSC not admitting their own liability. The company will pay $423,544 to the federal government and $189,756 to the state of Georgia, in addition to interest and legal fees accrued during the legal proceedings. The settlement also required GGNSC to enter into a Corporate Integrity Agreement (CIA) for its six skilled nursing centers located in the Atlanta area.

“Golden Living agreed to the settlement not to dignify these baseless charges, but because we would rather spend the money on our patient care and staff than on the legal fees necessary each month simply to respond to the government’s actions in the investigation,” said Golden Living President and CEO Neil Kurtz, M.D.

Mark F. Giuliano, Special Agent in Charge, FBI Atlanta Field Office, stated: “The FBI will continue to dedicate its investigative personnel and resources toward such cases of Medicaid and Medicare fraud as was seen here. These federally funded programs provide much needed services but are limited and healthcare providers that abuse these programs will be held accountable.”

“The Defense Criminal Investigative Service is committed to ensuring that TRICARE beneficiaries receive the high quality medical care that they deserve,” said John F. Khin, Special Agent in Charge, Southeast Field Office, Defense Criminal Investigative Service. “This settlement sends the message that providers of substandard care will be brought to justice through the collaborative efforts of law enforcement agencies and the Department of Justice.”