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Assisted living care manager must pay $14.9M to resolve insurance fraud claims

The Justice Department says the Florida company knowingly submitted claims that did not conform with Medicare, Medicaid and TriCare requirements.

A chronic disease management provider with several offices in Florida has agreed to pay $14.9 million to resolve alleged false claims.

The Department of Justice said that Bluestone Physician Services of Florida, Bluestone Physician Services and Bluestone National, operating in Florida, Minnesota and Wisconsin, respectively, agreed to the settlement recently.

The agency said the payment resolves allegations that the provider knowingly submitted claims for certain evaluation and management codes for services related to the management of chronic care patients in assisted living and other care facilities that did not conform with Medicare, Medicaid and TriCare requirements.

The federal government’s share of the settlement is $13,842,482, and $1,059,518 will be paid to Florida and Minnesota. A corporate whistleblower involved in the case will be paid more than $2.8 million.

A services description on a Bluestone Physician Services website said the company has provided residential care to elderly patients in assisted living, memory care and group home settings since 2006 and, in 2015, expanded to Florida.

The corporate description also said that Bluestone has corporate offices in Tampa and Orlando and serves communities in the Orlando, Jacksonville, Tampa and Sarasota areas. A corporate map on Bluestone's website also shows connections further south through Charlotte and Lee counties.

In connection with the settlement, Bluestone has entered into a five-year integrity agreement with the federal Department of Health and Human Services' Office of Inspector General, the Justice Department said. The agreement requires Bluestone to establish and maintain a compliance program and to submit to an independent review of Medicare claims to determine medically necessity and documentation accuracy.

The settlement includes the resolution of claims brought under the whistleblower provisions of the False Claims Act by Lisa Loscalzo, the former general manager for Bluestone’s Florida market. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery.

The settlement also includes the resolution of related allegations investigated by the U.S. Attorney’s Office for the District of Minnesota. Loscalzo will receive $2,831,380 in that settlement, the office confirmed.

WGCU Staff