Van Nuys Healthcare Center, a Five Star Quality Care skilled nursing facility in California, paid $1.14 million after its Director of Nursing and MDS Coordinator falsified Assessment Reference Dates on Medicare-required MDS reports to inflate reimbursement.

Van Nuys Healthcare Center (CA) — Falsified MDS Assessment Dates, $1.14M Penalty (2019)

Outcome: Five Star Quality Care-CA LLC, doing business as Van Nuys Healthcare Center, a skilled nursing facility in Van Nuys, California, paid $1,138,807.29 after its Director of Nursing and MDS Coordinator were found to have falsified Assessment Reference Dates on MDS (Minimum Data Set) reports required under Medicare billing rules.

Van Nuys Healthcare Center is part of the Five Star Senior Living national network. The facility's Director of Nursing and MDS Coordinator — the two key individuals responsible for Medicare billing compliance — manipulated Assessment Reference Dates on the MDS assessments submitted to Medicare. Under the pre-PDPM Medicare SNF payment system, Assessment Reference Dates determined which reimbursement period applied and at what RUG (Resource Utilization Group) category — meaning falsified ARDs could directly inflate Medicare payments.

This case illustrates a sophisticated form of SNF billing fraud: rather than simply billing for services not rendered, the scheme involved manipulating the timing of assessments to maximize reimbursement during high-therapy periods. The settlement of $1,138,807.29 was reached June 28, 2019 through the OIG's self-disclosure program.

Primary Source: OIG Enforcement Record