Whistleblower alleges nursing home overbilled Medicare

On Behalf of | Apr 29, 2015 | Whistle-blower Claims

Wisconsin residents may be interested in a lawsuit filed under the False Claims Act in 2009 against a chain of nursing homes. The suit states nursing home residents were put through physical therapy regimens that were billed at a higher rate to increase profits. On April 14, the U.S. Department of Justice announced it was intervening in the case.

The case deals with the nursing home chain’s use of high-tiered Medicare billing. Some services such as rehabilitation are billed at a higher rate. The Virginia therapist filed the suit, contending the chain used rehabilitative services whether needed or not, to increase revenue. Medicare will authorize up to 100 days of such care per year.

One elderly resident in a Florida facility, placed in the home for hospice care, was given over three months of rehabilitative therapy. The whistleblower lawsuit alleges that this was done routinely because of company pressure on administrators.

Investigations into the chain have shown that higher rate rehabilitative services were billed for 39 percent of the chain’s residents in 2006. By 2009, the number increased to 80 percent. An asset management group purchased the chain in 2007, paying $6.3 billion for the acquisition. Estimates of overbilling paid by Medicare reported in the lawsuit topped $6 billion.

The Virginia occupational therapist filed the suit after witnessing the use of fraudulent billing of government programs. If, after investigating the situation, the government takes over the case and reparations are made, the individual who initially filed the lawsuit may be eligible to receive 15 to 25 percent of the reparations.

If an individual witnesses a fraudulent act perpetrated against a government agency, he or she may benefit from speaking with an attorney. The attorney may evaluate the circumstances and, if appropriate, help in filing a whistleblower lawsuit.

Source: ABC News, “US Intervenes in Whistleblower Cases Against Nursing Homes,” Matthew Barakat, April 21, 2015


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