PHILADELPHIA, PA — A federal court has entered a consent judgment requiring Segal Arts, LLC, and its owner, Irina Segal, to pay $200,000 to resolve allegations that they improperly billed Medicare for services not provided, U.S. Attorney David Metcalf announced.
The judgment, issued by the United States District Court for the Eastern District of Pennsylvania, stems from a civil complaint alleging violations of the False Claims Act.
According to the complaint, Segal Arts billed Medicare for one-on-one occupational therapy services that were not performed.
Instead, the company allegedly provided group arts-and-crafts sessions to Medicare beneficiaries at assisted living and similar facilities in Pennsylvania and New Jersey.
Prosecutors said the billed services were described as medically necessary one-on-one therapeutic exercises, which differ from the group activities that were provided.
The complaint further alleges that Segal continued the billing practices after being interviewed and informed by agents from the U.S. Department of Health and Human Services Office of Inspector General about the requirements tied to the billing code used.
Authorities said Segal Arts did not repay Medicare for the reimbursements tied to the group sessions before the government filed its complaint.
Under the consent judgment, Segal agreed to repay $200,000, an amount the government said was based on her ability to pay.
“This investigation and its resolution by consent judgment reflect our ongoing focus on pursuing individuals who defraud Medicare,” Metcalf said in a statement.
Maureen Dixon, special agent in charge of the HHS-OIG Philadelphia Regional Office, said civil enforcement actions help protect Medicare funds.
“This agreement demonstrates our commitment to ensuring that Medicare program dollars are only paid for services that were actually provided to patients,” Dixon said.
The case is captioned United States of America v. Segal Arts, LLC, Civil No. 26-1693 in the Eastern District of Pennsylvania.
The investigation was conducted by the U.S. Department of Health and Human Services Office of Inspector General.
The case is being handled by Assistant U.S. Attorney Rebecca S. Melley and litigative consultant Priscilla Brandon.
The allegations in the complaint are claims only, and there has been no determination of civil liability.
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