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Catch of the Week -- Signature HealthCARE

Posted  06/15/18
In a major victory for patients and taxpayers alike, DOJ announced an over $30 million settlement with Signature HealthCARE, LLC, a Kentucky-based company accused of overbilling federal healthcare programs for rehabilitation and skilled-nursing services. As a prime example of how valuing profits over patients can lead to fraudulent behavior, Signature HealthCARE wins the title of Catch of the Week. The settlement...

Tagged in: Catch of the Week, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Provider Fraud, SNF, Whistleblower Case,

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June 8, 2018

Skilled nursing facility company Signature HealthCARE, LLC will pay more than $30 million to the federal and Tennessee state governments to resolve False Claims Act allegations it placed patients in the highest therapy reimbursement level regardless of need; limited its therapy services to the minimum number of minutes required to bill at a given reimbursement level and discouraged the provision of care beyond that minimum; and pressured therapists to complete therapy even when patients were too ill or declined to participate. The suit was brought by two former employees and whistleblowers, who will receive a portion of the recovery. DOJ

Tagged in: FCA Federal, FCA State, Lack of Medical Necessity, Medical Billing Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

March 29, 2018

Louisville-based skilled nursing facility New Oaklawn Investments, LLC (d/b/a Oaklawn Health and Rehabilitation Center and Elmcroft Senior Living, Inc.) agreed to pay roughly $5 million to resolve allegations it violated the False Claims Act by submitting false claims to Medicare for patient rehabilitation services at the resource utilization (“RUG”) Code Series Rehabilitation Ultra High and Rehabilitation Very High, for certain services that were not reasonably or medically necessary. DOJ (WDKY)

Tagged in: Defendants, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, SNF, Upcoding,

March 22, 2018

Four Maryland skilled nursing facilities and two consulting companies, Caring Heart Rehabilitation and Nursing Center, GNH, LLC, OPOP, LLC, Riverview SNF, LLC, Global Healthcare Services Group, LLC, and GHC Clinical Consultants, LLC, agreed to pay a total of $6 million to settle claims of violating the False Claims Act by billing Medicare for skilled therapy services that were either not delivered or not medically necessary. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblower will receive an award of $990,000 from the proceeds of the government’s recovery. DOJ (MD)

Tagged in: FCA Federal, Lack of Medical Necessity, SNF, Whistleblower Case, Whistleblower Rewards,

February 2, 2018

Memphis Operator, LLC (d/b/a Spring Gate Rehabilitation and Healthcare Center) agreed to pay $500,000 to settle claims of violating the False Claims Act for billing Medicare for services to residents of Spring Gate that were materially substandard, worthless and were provided in violation of certain essential requirements that the United States expects skilled nursing facilities to meet. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (WDTX)

Tagged in: FCA Federal, SNF, Whistleblower Case, Whistleblower Rewards,

Florida Judge Erases $350M Jury Verdict in FCA Case

Posted  01/18/18
By the C|C Whistleblower Lawyer Team Last Thursday, a judge in the Middle District of Florida threw out a $350M jury verdict against a nursing home provider. The basis of the decision was a stringent interpretation of the FCA’s materiality element. The ruling heavily relied upon the 2016 Supreme Court decision in Universal Health Services v. Escobar. This is the latest example of that ruling being hashed out in...

Tagged in: Court Decision, FCA Materiality, SNF,

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November 16, 2017

Georgia-based not-for-profit Hyperion Foundation, its former president Julie Mittleider, Georgia-based nursing home management company AltaCare Corporation, its CEO Douglas Mittleider, and related companies Long Term Care Services Inc. and Sentry Healthcare Acquirors Inc. agreed to pay $1.25 million to resolve allegations of violating the False Claims Act by providing grossly substandard care to residents at the Oxford Health and Rehabilitation nursing home in Mississippi when it was operated by AltaCare under a contract with Hyperion.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by Academy Health Center Inc., the owner and landlord of the Mississippi skilled nursing facility.  Academy will receive a whistleblower award in an undisclosed amount from the proceeds of the government's recovery.  DOJ

Tagged in: FCA Federal, Medical Billing Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

November 16, 2017

Four San Diego-area nursing homes owned by Los Angeles-based Brius Management Co. agreed to pay as much as $6.9 million to resolve allegations of violating the False Claims Act and Anti-Kickbacks Statute by paying kickbacks for patient referrals to discharge planners at Scripps Mercy Hospital San Diego.  The four nursing homes involved are Point Loma Convalescent Hospital, Brighton Place – San Diego, Brighton Place – Spring Valley, and Amaya Springs Health Care Center.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Viki Bell-Manako, a former employee of one of the Brius nursing homes.  She will receive a whistleblower award of 20% of the proceeds of the government's recovery.  DOJ (CDCA)

Tagged in: Anti-Kickback and Stark, FCA Federal, SNF, Whistleblower Case, Whistleblower Rewards,

July 17, 2017

Ohio-based nursing home operators Foundations Health Solutions Inc., Olympia Therapy Inc. and Tridia Hospice Care Inc., and their executives Brian Colleran and Daniel Parker, agreed to pay roughly $19.5 million to resolve allegations they violated the False Claims Act by submitting to Medicare claims for medically unnecessary rehabilitation therapy services and for hospice services to patients not eligible for the Medicare benefit, and by soliciting and receiving kickbacks to refer patients from their skilled nursing facilities to home health care provider Amber Home Care LLC.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by former Olympia employee Vladimir Trakhter and former Tridia employees Paula Bourne and La’Tasha Goodwin.  Mr. Trahkter will receive a whistleblower award of roughly $2.9 million and Ms. Bourne and Ms. Goodwin collectively will receive an award of roughly $740,000, all from the proceeds of the government’s recovery.  Whistleblower Insider

Tagged in: Anti-Kickback and Stark, Home Health and Hospice, Lack of Medical Necessity, Multiple Whistleblowers and First-to-File, SNF, Whistleblower Case, Whistleblower Rewards,

July 14, 2017

Rodney Hesson and Gertrude Parker, owners of Nursing Home Psychological Services and Psychological Care Services, were respectively sentenced to 180 months and 84 months in prison and to respectively pay $13.8 million and $7.3 million in restitution for their involvement in a $25.2 million Medicare fraud scheme involving billing Medicare for psychological testing services that nursing home residents did not need or in some instances did not receive.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicare, SNF,

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