By Danielle M. Murray, J.D.
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) is investigating a Tennessee-based nursing care company. The company runs more than 200 skilled nursing homes (SNFs), assisted living facilities (ALFs), retirement living communities, home care services, and Alzheimer's centers across the country. The nursing care company is accused of defrauding Medicare of millions of dollars for unnecessary and expensive therapy treatments from 2006 to 2011, according to the Wall Street Journal.
Click here to read the entire article from the Wall Street Journal.
Nursing Care Company Allegedly Used False Records and Statements to Overbill Medicare.
According to the federal complaint, the nursing care company is accused of encouraging its employed therapists to perform unnecessary and expensive therapy treatments that were billed to Medicare. The document mentioned specific cases of patients who allegedly didn’t need therapy or could have been harmed by it, but received it anyway.
In addition to Medicare, Tricare was also allegedly billed for high-priced nursing care performed at facilities that are affiliated with the nursing care company.
Representatives Defend Billing and Treatment Methods.
Representatives from the nursing care company posted an open letter on its website. It calls the lawsuit an attempt by the federal government to target companies that provide rehabilitation therapy services. It also denies the allegations of fraudulent billing.
Click here to read the entire letter.
Two Whistleblowers Spark Investigation.
Two former employees filed separate cases against the nursing care company, according to a Times Free Press article. In 2008, a former staff development coordinator working in Tennessee filed a complaint alleging Medicare fraud. In the same year, a former occupational therapist who had worked for the company in Florida, made similar complaints. The government decided to combine their lawsuits and is currently investigating. Be sure to check this blog in the future for updates to this story.
To read the Times Free Press article, click here.
What You Need to Know about Medicare and Medicaid Audits.
The Health Law Firm’s President and Managing Partner George F. Indest III wrote a two-part blog on the increased number of Medicare and Medicaid audits being initiated against health professionals who treat assisted living facility (ALF) and SNF residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because this area of medical practice has been identified as one fraught with fraud and abuse. To learn more on the areas being targeted and how to respond to different types of audits, click here for the first blog and here for the second.
Contact Health Law Attorneys Experienced with Medicaid and Medicare Qui Tam or Whistleblower Cases.
In addition to our other experience in Medicare, Medicaid and Tricare cases, attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters.
To learn more on our experience with Medicaid and Medicare quit tam or whistleblower cases, visit our website. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Do nursing care companies need stricter oversight? Have you noticed an increase in Medicare or Medicaid audits in your practice area? Please leave any thoughtful comments below.
Burton, Thomas. “Medicare Fraud is Charged.” Wall Street Journal. (December 3, 2012). From: http://online.wsj.com/article/SB10001424127887323717004578157640024945594.html?mod=googlenews_wsj
Harrison, Kate and South, Todd. “Probe Reveals Claims of Unnecessary Therapies at Cleveland-based Life Care Centers.” Times Free Press. (December 16, 2012). From: http://www.timesfreepress.com/news/2012/dec/16/dying-patients-unneeded-therapy-life-care-center/?print
Life Care Centers of America. “Open Letter to Life Care Associates and Medical Professionals.” Life Care Centers of America. (November 30, 2012). From: http://lcca.com/openletter/
About the Author: Danielle M. Murray is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
Tag Words: Medicare fraud, Medicare, Medicare audit, Tricare, Tricare fraud, Tricare audit, whistleblower, qui tam suits, false records, false statements, nursing care company, unnecessary treatment, nursing home, Medicare defense attorney, Medicare defense lawyers, whistleblower protection, legal representation, skilled nursing facility, Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS)
"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999. Copyright © 1996-2012 The Health Law Firm. All rights reserved.