The United States District Court for the Eastern District of Pennsylvania has entered a consent judgment against Segal Arts, LLC, and its owner Irina Segal, according to a Mar. 18 announcement by U.S. Attorney David Metcalf. The judgment resolves allegations that the Bucks County company submitted false claims to Medicare by billing group art classes as one-on-one occupational therapy services.
The case is significant because it addresses concerns about the misuse of Medicare funds and the importance of ensuring that older adults receive medically necessary care. Authorities allege that instead of providing individual therapeutic exercises as billed, Segal Arts conducted group arts-and-crafts sessions at assisted living and similar facilities in Pennsylvania and New Jersey.
“This investigation and its resolution by consent judgment reflect our ongoing focus on pursuing individuals who defraud Medicare, especially when occupational therapy providers in the Medicare program should be providing medically necessary services to our older adult populations,” said U.S. Attorney Metcalf.
Maureen Dixon, Special Agent in Charge of the Philadelphia Regional Office for the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), said: “Civil enforcement is an important component in safeguarding the integrity of the Medicare program. This agreement demonstrates our commitment to ensuring that Medicare program dollars are only paid for services that were actually provided to patients.”
According to the complaint, even after being interviewed and educated by HHS-OIG agents about proper billing requirements, Segal Arts did not repay amounts reimbursed for non-covered group art sessions. Under the consent judgment, Segal must repay $200,000 based on her ability to pay.
The case was investigated by HHS-OIG and is being handled by Assistant U.S. Attorney Rebecca S. Melley and litigative consultant Priscilla Brandon. Officials note that all claims are allegations only and there has been no determination of civil liability.
