Justice Department Investigation into Health Care Fraud
Analysis Group supported the US Department of Justice (DOJ) in this Medicare fraud matter involving The Ensign Group Inc. (Ensign), a national operator of assisted living and rehabilitation facilities. As part of an initiative to curb Medicare overbilling, the DOJ, in cooperation with the US Attorney for Central California and the US Department of Health and Human Services, initiated an investigation into the billing and reimbursement practices of some of Ensign's subsidiaries. According to the investigation's findings, Ensign was allegedly overpaid by federal health care programs. The Analysis Group team was led by Senior Advisor Bruce Strombom and Vice President Peter Simon. Dr. Simon was retained as an expert to provide advice on statistical sampling and corresponding analysis in order to estimate amounts overcharged to Medicare. Specifically, Dr. Simon selected a random sample of claims and extrapolated overcharges to the full set of claims at issue. Ensign agreed to a $48 million settlement with the DOJ to resolve and conclude the investigation.