As lives wind down, some people require assistance with everyday tasks. One of the companies that caters to the growing population needing skilled nursing assistance is Life Care Centers of America Inc.
The national chain of nursing facilities recently agreed to a $145 million payout to settle a lawsuit that alleged that it violated the False Claims Act when it billed Medicare and TRICARE for rehabilitation therapy services that were not needed.
Medicare reimburses skilled nursing facilities for skilled therapy and nursing needs. When qualifying patients have greater need for these services, the reimbursement is likewise higher. A recent news article points out that Medicare has a “Ultra High” designation for patients who need at least 720 minutes of therapy in two disciplines ((e.g., speech, physical, occupational) five days per week.
In the lawsuit, it was alleged that Life Care had a company-wide practice designed to increase the number of Ultra High beneficiaries regardless of whether the patients needed that level of care or not. That approach resulted in some patients getting unreasonable, unneeded therapy services for which Life Care was reimbursed.
In addition to the millions paid out, the company has agreed to a five-year review process that will each year assess the necessity of its Medicare-billed therapy services.
The settlement resolves a pair of lawsuits against the company and its owner; qui tam claims filed by a pair of former Life Care employees. The whistleblowers in this case will share $29 million.
The whistleblower attorneys of Alan C. Olson & Associates, s.c., can help Milwaukee residents file qui tam claims as well.
