Nursing Home Health System Agrees to Pay $1.75 Million to Settle False Claims Act Allegations

A nursing home health system has agreed to pay the United States $1.75 million to resolve its potential liability under the False Claims Act for facilitating COVID-19 vaccinations for hundreds of individuals ineligible to participate in the Centers for Disease Control and Prevention’s (CDC) Pharmacy Partnership for Long-Term Care Program (LTC PPP), a program specifically designed to vaccinate long-term care (LTC) facility residents and staff when doses of COVID-19 vaccine were in limited supply at the beginning of the CDC COVID-19 Vaccination Program. The company is a not-for-profit corporation located in Florida that oversees healthcare facilities on its campus, including a nursing home and an assisted living facility. 

The CDC announced the launch of the LTC PPP in October 2020. Because the LTC facility population was at the highest risk of COVID-19 infections, the CDC created the LTC PPP to prioritize vaccinations of that population as quickly as possible and while vaccine availability was limited. Under this program, the CDC engaged with pharmacy partners to provide “end to end” management of the COVID-19 vaccination process, including conducting on-site vaccination clinics at the nursing homes and other LTC facilities.  

The company enrolled in the LTC PPP and scheduled its first vaccination clinic on Dec. 31, 2020, for residents and staff of a skilled nursing facility on its campus. The settlement resolves allegations that the company knew that the LTC PPP covered only LTC facility residents and staff, but nevertheless invited and facilitated the vaccination of hundreds of ineligible persons at the clinic by characterizing them as “staff” and “volunteers,” many of whom they targeted for donations. Specifically, the United States alleged that the company (1) characterized board members as “staff,” (2) directed the organization’s fundraising arm to invite donors and potential donors to the vaccination clinic, and (3) allowed the company’s vice chairman of the board and his brother to invite close to 300 ineligible individuals to receive the vaccine there.  

Ultimately, the United States alleged that of 976 persons vaccinated at the Dec. 31, 2020, clinic, 567, or more than half, were ineligible to participate in the LTC PPP.    

The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, and the US Attorney’s Office for the Southern District of Florida, with substantial assistance from HHS-OIG, the FBI, and the CDC.  

Issue: 

Under the False Claims Act, no specific intent to defraud is required. “Knowing” is defined to include not only actual knowledge but also instances in which the person acted in deliberate ignorance or reckless disregard of the truth or falsity of the information. The LTC PPP vaccination program was designed to protect nursing home residents at a critical time when the COVID-19 pandemic was devastating that population. Characterizing members of various boards of directors and their family members and friends as staff, and classifying potential donors and non-affiliated individuals as volunteers to facilitate their vaccination is a violation of the False Claims Act.  

Discussion Points 

• Review policies and procedures for preventing and reporting a false claim. Update your policies and procedures as needed. 
• Train staff on the False Claims Act and what can be considered a false claim. Include information on how to report concerns and suspected violations, and that prompt reporting is mandatory. Document that the trainings occurred and place in each employee’s education file. 
• Periodically perform audits to ensure all staff are aware of their responsibility to identify and report compliance and ethics concerns and understand that it is their responsibility to report violations to their supervisor, the compliance officer, or via the anonymous hotline in a timely manner. Before submitting claims to any government agency, review to ensure documentation and categories of billing codes are accurate.