PHILADELPHIA - U.S. Attorney David Metcalf announced today that the United States District Court for the Eastern District of Pennsylvania has entered a consent judgment against Segal Arts, LLC, and its sole owner and manager, Irina Segal. In its complaint against Segal and her business, the United States alleges that they violated the False Claims Act, 31 U.S.C. § 3729-3733, by submitting or causing the submission of claims for payment to Medicare for one-on-one occupational therapy services that were not provided. Instead of the medically necessary one-on-one therapeutic exercise described in Segal Arts' Medicare billing, Segal Arts provided group arts-and-crafts sessions to Medicare beneficiaries 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.

"Civil enforcement is an important component in safeguarding the integrity of the Medicare program," said 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). "This agreement demonstrates our commitment to ensuring that Medicare program dollars are only paid for services that were actually provided to patients."

Among other things, the complaint alleges that, even after Segal was interviewed and educated by HHS-OIG agents about the individual, skilled therapy requirements associated with the Current Procedural Terminology (CPT) code used in the billing, Segal Arts failed to repay to the Medicare program the amounts it had reimbursed for non-covered, group art sessions. The consent judgment requires Segal to repay $200,000, based on her ability to pay.

The allegations are described in detail in the complaint. The case is captioned United States of America v. Segal Arts, LLC, Civil No. 26-1693 (E.D. Pa.).

The case was investigated 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.

All claims in the complaint are allegations only. There has been no determination of civil liability.