SIOUX CITY -- Health care facilities in Sergeant Bluff and in Elk Point, South Dakota, are among five accused of filing more than $3.1 million in fraudulent Medicare claims.
A U.S. Attorney's Office complaint says that Sergeant Bluff Healthcare and Elk Point Healthcare filed Medicare claims from January 2012 through December 2015 for home health services billed by a third-party provider for services that did not qualify for Medicare coverage and were not justified or necessary considering the patients' medical conditions. For most of that time, the facilities were managed by a Minnesota company that has since gone out of business.
Filed Tuesday in U.S. District Court in Sioux City, the complaint said the facilities filed the Medicare claims despite billing reports that showed the third-party providers were providing "an extreme amount" of therapy services on average per patient. Rather than take steps to address those reports, the facilities continued submitting the claims for Medicare reimbursement.
The federal government is seeking more than $1.245 million from Sergeant Bluff Healthcare, which operated Embassy Healthcare Community, and $788,484 from Elk Point Healthcare #1, which operated Prairie Estates Healthcare Community. The facilities had been managed by Welcov Entities, of Edina, Minnesota, until 2018, when Lantis Enterprises resumed management of them. Based in Spearfish, South Dakota, Lantis had begun leasing the facilities to Welcov in 2012.
Lantis chief executive officer Wendy Soulek said her company took over management of the facilities last year after Welcov failed to pay Lantis. Soulek said she had not seen the complaint and was not aware of the allegations contained in it.
Under Lantis' management, the facilities now operate as WEL-Home Health and Embassy Rehab & Care Center in Sergeant Bluff and WEL-Home Health and Prairie Estates Care Center in Elk Point.
According to a story on SkilledNursingNews.com, Welcov was forced to file for bankruptcy and owed more than $17.5 million to its creditors. The company earlier this year reached a settlement in which the bankruptcy petition was dismissed to facilitate the transfer of Welcov's remaining facilities to new operators who could keep them open for the residents living in them, the Skilled Nursing News website said. Welcov is no longer in business.
The federal complaint said that facilities in Red Oak, Iowa, Logan, Iowa, and Flandreau, South Dakota, also filed fraudulent Medicare claims. Those facilities also had been managed by Welcov. Lantis now manages the two Iowa locations.