A large nursing home operator in the south has settled a whistleblower lawsuit for more than $30 million. Signature HealthCARE, LLC, owns roughly 125 facilities and regularly seeks reimbursement from Medicare. Two former therapy employees for the nursing home company noted that the facilities were billing Medicare for rehabilitation therapy services that were over-inflated. An investigation revealed that the company billed Medicare for services that were not reasonable, necessary, and skilled, according to the Department of Justice.
The former therapy workers initiated a lawsuit on behalf of the government under the False Claims Act to recover taxpayer money that was fraudulently obtained. The whistleblowers will receive a percentage of the $30 million recovered in the settlement, however, the DOJ has not yet revealed the amount the whistleblowers will receive for uncovering the allegations.
Billing For Unnecessary Therapy Services
In essence, the lawsuit claims that the health care company provided nursing home patients with rehabilitation services that they did not necessarily need, or otherwise overreported services that were provided, to artificially inflate the bills to Medicare. Billing Medicare for services that are not medically necessary is problematic as the bills deplete resources intended for patients in need. The lawsuit included evidence that the health care company submitted forged documents that were intended to certify the patients' need for skilled medical or therapy services.
The DOJ says that the company put its own financial interests ahead of the needs of patients. The lawsuit says that the therapy services provider manipulated practices to schedule therapy to increase corporate profits without regard for the needs of patients. Obtaining reimbursements through schemes like this is "not only stealing from the federal taxpayer, but also from people who rely on federally funded programs for their health care needs," according to Murang Pak, Acting Special Agent in Charge of FBI Atlanta.