October 17, 2014 — Medicare exists to help seniors who need and deserve medical treatment. Medicare fraud by unethical nursing homes or the medical providers with whom they contract only makes health care costs more expensive for everyone. The U.S. Justice Department depends on courageous whistleblowers to notify the government about Medicare fraud by bringing a False Claims Act lawsuit. The statute’s qui tam language gives insider employees a way to do the right thing and be rewarded for it. Tipsters who file suit for the taxpayers’ benefit are eligible to receive a sizable share of any proceeds from the suit.
EMA Allegedly Caused The Submission Of False Claims To Medicare By Failing To Prevent Its Independent Contractor From Violating Medicare Requirements In Billing For The Provision Of Physical Therapy Services
Episcopal Ministries to the Aging Inc. (EMA) has agreed to settle False Claims Act allegations for $1.3 million. EMA is a nonprofit Maryland corporation that owns skilled nursing facilities providing rehabilitation services.
The allegations against EMA center around one of the company’s skilled nursing facilities in Easton, Maryland, William Hill Manor. In 2010, EMA contracted with RehabCare Group East Inc., a subsidiary of Kindred Healthcare Inc., to provide rehabilitation therapy for William Hill Manor patients who needed it.
RehabCare, however, provided Medicare beneficiaries with therapy services that were either unnecessary or unreasonable. In so doing, RehabCare was able to milk the system for reimbursements to which it was not entitled. EMA did nothing to prevent RehabCare’s disregard of Medicare requirements in providing physical therapy or in its unscrupulous Medicare billing practices. RehabCare’s alleged abuses of the system included the following:
- therapy services allegedly provided by RehabCare did not taper off as would be expected as improvement occurred over the course of the patient’s stay and treatment.
- of evaluating patients individually to determine the appropriate level of therapy, RehabCare pegged patients in a therapy routine that would return the highest Medicare reimbursement level until it became clear that they were not physically capable of that degree of activity.
- RehabCare ignored the Medicare requirement that the duration of a patient’s therapy session should be governed by the person’s particular needs, and instead gave patients the minimum number of therapy minutes required to qualify for the highest Medicare reimbursement level. In addition, RehabCare discouraged therapists from exceeding that minimum threshold.
With this settlement, the Justice Department made clear that nursing home operators must ensure that their health care contractors offering physical therapy services to nursing home patients comply with applicable Medicare requirements.
False Claims Act Lawsuits Target Abuse By Medical Providers
While Waters & Kraus is not handling this particular False Claims Act case, we are representing whistleblowers in similar lawsuits. If you have comparable claims against a different medical provider, contact us or call our qui tam attorneys at 855.784.0268 to learn more about our practice and how we can work together to notify the government about fraudulent abuses of government-funded programs. George Tankard and Anne Izzo, qui tam lawyers in Waters & Kraus’ Maryland office, where the fraud in this case occurred, protect tipsters throughout the whistleblower lawsuit process.
