A New Day for Data Whistleblowers: DOJ Joins First False Claims Act Case Brought by Data Analysis Firm Whistleblower
Posted 06/17/21
Upcoding
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May 21, 2021
SavaSeniorCare LLC and related entities (“Sava”) will pay $11.2 million, plus potentially more pursuant to an “ability-to-pay” settlement, to resolve allegations that Sava violated the False Claims Act by causing its skilled nursing facilities to bill Medicare for rehabilitation therapy services that were not reasonable, necessary, or skilled, and that Sava billed the Medicare and Medicaid programs for grossly substandard (i.e., “worthless”) skilled nursing services. The settlement stems from four separate qui tam complaints filed by whistleblowers Rita Hayward, Trammel Kukoyi, Terrence Scott, James Thornton, and Barbara Roberts, who will share an undisclosed portion of the government’s recovery. In 2015, the United States intervened in the litigation and filed a consolidated False Claims Act complaint, alleging inter alia that Sava had exerted significant pressure on its skilled nursing facilities to meet unrealistic corporate targets for the highest Medicare reimbursement rates without regard to patients’ actual clinical needs, and improperly delayed the discharge of patients from its facilities in order to increase billings. Sava will enter into a five-year Corporate Integrity Agreement as part of the settlement. DOJApril 19, 2021
Maryland physician Njideka Udochi of Millennium Family Practice will pay $660,000 to resolve allegations that she submitted false claims for auricular stimulation, or "P-Stim," devices. Udochi billed Medicare using a billing code covering the surgical implantation of a type of neurostimulator, but P-Stim devices are not surgically implanted, and are not approved for reimbursement from Medicare. USAO MDDecember 2, 2020
The owner and operator of Atlanta-based Elite Homecare has been sentenced to over five years in prison and ordered to pay $999,999 in restitution for defrauding Medicaid of nearly $1 million. As a provider under the Georgia Pediatric Program (GAPP)—an in-home nursing program for Medicaid-eligible children with severe physical and cognitive disabilities—Diandra Bankhead allegedly submitted thousands of claims for services that were fraudulent in a myriad of ways. Some of the claims falsely represented that employees provided more than 24 hours of services in a given day to multiple children simultaneously (including to children whose families had not retained Elite, and by RNs who did not know their credentials were being used), while other claims contained fraudulent credentialing information and fraudulent supporting documentation, or were upcoded to induce higher payments from Medicaid. Additionally, Bankhead allegedly “sold” information about twenty of Elite’s former clients to another Atlanta-based home health provider in exchange for a percentage of the reimbursements from Medicaid. USAO NDGASeptember 3, 2020
Having previously pleaded guilty to healthcare fraud and related charges, Arizona urgent care provider UCXtra Umbrella, LLC, which did business as "Urgent Care Extra," was sentenced to pay restitution of $12.5 million. Defendant admitted that it ordered tests and procedures that were not medically necessary and that its billings intentionally overstated the complexity of services to patients in order to receive inflated reimbursements from private insurance companies. USAO AZWindfall to Health Insurers Due to COVID-19 Is Not Yet Resulting in Resolution of FCA Risk Adjustment Cases
Posted 08/21/20
