Whistleblower-Initiated Case: DOJ Files FCA Complaint Against Priority Hospital Group and Three LTCHs
By the Constantine Cannon Whistleblower Team
On January 16, the government filed a False Claims Act complaint against Priority Hospital Group LLC (PHG), a Louisiana-based hospital management company, three PHG-managed long term care hospitals, and a doctor alleging they submitted false claims for medically unnecessary care and engaged in improper patient referrals in violation of the Anti-Kickback and Stark Law.[1]
What Are LTCHs and What Was the Alleged Scheme?
Long term care hospitals (LTCHs) offer inpatient hospital services for patients with medically complex conditions that require long hospital stays and programs of care. Medicare reimburses LTCHs on a patient’s length of stay. Allegedly, PHG and the LTCH defendants held patients in the hospital longer than medically necessary to increase Medicare reimbursements.
LTCHs Named in the Complaint
The LTCHs named in the United States’ complaint include the following: Riverside Hospital LLC and Riverside Hospital of Louisiana, Inc. (collectively doing business as Riverside Hospital); Post Acute Enterprises, LLC (doing business as Mid Jefferson Extended Care Hospital); and New Lifecare Hospital of North Louisiana, LLC (doing business as Ruston Regional Specialty Hospital).[2]
Reportedly Delayed Discharging Some Patients, Increasing Payments from Medicare
The government alleges that PHG and the LTCH defendants delayed discharging some patients, even when their treatment courses had been completed or when they could have been transferred to a lower level of care, which would have led to lower payments from Medicare.[3]
The complaint further alleges that Riverside Hospital of Louisiana entered into medical directorship agreements with a doctor and provided payments to induce him to refer patients to Riverside, violating the Anti-Kickback Statute and Stark Law.
The Anti-Kickback Statute and Stark Law
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving payments for items or services covered by Medicare and other federally funded programs. The Stark Law prevents hospitals from billing Medicare for certain services referred by physicians with financial ties to the hospital. Both laws aim to ensure that medical providers make decisions based on patient welfare, free from improper financial incentives.
How Can Whistleblowers Report Healthcare Fraud?
Whistleblowers can speak up if they have any information pertaining to healthcare fraud. This lawsuit was filed under the qui tam, or whistleblower provisions of the False Claims Act, allowing private parties to file lawsuits on behalf of the government and receive up to 30% of successful recoveries. The whistleblower in this case is Michaela DeVos, a former employee of Riverside Hospital.[4]
According to Constantine Cannon Partner Marlene Koury, “By pursuing this matter, the government reaffirms its focus on healthcare fraud and continues to rely on the False Claims Act as a cornerstone of enforcement.”
Constantine Cannon Represents Whistleblowers
Our firm has extensive experience representing whistleblowers. If you think you have a case or have questions about what it means to be a whistleblower under the various government programs, please contact us. We will connect you with an experienced member of our whistleblower team for a free and confidential consultation.
Speak Confidentially With Our Whistleblower Attorneys
Sources:
[1] See https://www.justice.gov/opa/pr/justice-department-files-false-claims-act-complaint-against-priority-hospital-group-and.
[2] See https://www.justice.gov/opa/media/1424361/dl
[3] Id.
[4] Id.
Tagged in: Anti-Kickback and Stark, False Claims Act, Medicare, qui tam,