Consumer Fraud

U.S. Backs Whistleblower Complaints of Medicare fraud Against National Nursing Home Operator

Pills Stethascope on Money 435x289 U.S. Backs Whistleblower Complaints of Medicare fraud Against National Nursing Home OperatorAfter investigating three separate lawsuits filed against an Atlanta-based national nursing home operator under the False Claims Act, the U.S. government has chosen to back the allegations of Medicare fraud expressed in the lawsuits and combine them into one consolidated complaint.

According to the U.S. Department of Justice (DOJ), SavaSeniorCare and its related facilities, which operate about 200 nursing facilities in 23 states, “knowingly and routinely submitted false claims to Medicare for rehabilitation therapy services that were not medically reasonable and necessary.”

Federal prosecutors allege that Sava strongly pressures its skilled nursing facilities to meet unrealistic financial goals. To achieve these unrealistic goals, the nursing facilities in the Sava network provided “medically unreasonable, unnecessary and unskilled services to Medicare patients.”

Sava determined and set these aggressive, prospective corporate targets for the highest Medicare reimbursement rates in an effort to boost its Medicare revenues without regard for the actual clinical needs of its patients, then pressured its staff to meet those goals, federal prosecutors allege.

Additionally, the DOJ says Sava delayed discharging patients from its facilities, even though the patients were medically ready to be discharged, so it could significantly increase its Medicare payments.

“The provision of Medicare benefits must be dictated by patient need, not by Medicare providers’ efforts to maximize profits by pressuring their employees to provide medically unnecessary services,” said Principal Deputy Assistant Attorney General Benjamin Mizer of the Justice Department’s Civil Division. “The Department of Justice will continue to aggressively pursue companies that seek to engage in this kind of fraudulent scheme.”

The three lawsuits were filed under the qui tam, or whistleblowerprovisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery.  The law allows the federal government to review FCA lawsuits and back them, which it has done in this case. FCA lawsuits filed by private whistleblowers may proceed whether or not the government chooses to become involved.

Under the False Claims Act, a defendant that is found liable is subject to damages equal to three times the government’s loss plus applicable penalties. Whistleblowers who helped bring about the recovery are awarded between 15 and 30 percent of the total amount recovered, ensuring that the government still recovers the full amount of its Medicare losses.

Source: The U.S. Department of Justice