March 28, 2013 — Over the last four years, the U.S. Justice Department has relied upon the federal False Claims Act to recoup over $10 billion in fraudulent Medicare and Medicaid cases. The anti-fraud statute gives the Justice Department an effective weapon for attacking fraud against the American government. The False Claims Act’s qui tam language allows a whistleblower to file a lawsuit on behalf of the United States and to participate in any recovery.
U.S. Alleges Tennessee Nursing Home Affiliates Billed Medicare for Unnecessary Therapy
Grace Healthcare LLC, a nursing home manager based in Chattanooga, Tennessee, and its affiliate Grace Ancillary Services LLC (collectively, Grace) have reached a $2.7 million settlement in a False Claims Act suit filed by a former Grace employee, the Justice Department has announced. The lawsuit alleged that Grace intentionally submitted false claims to Medicare and TennCare/Medicaid for rehabilitation therapy that was medically unreasonable and unnecessary.
Grace Healthcare LLC owns and/or operates many skilled nursing facilities in Tennessee. Grace Ancillary Services LLC provided patients in some of those facilities with all sorts of therapy. Between 2007 and 2011, the suit alleged, Grace pressured therapists in ten different nursing home facilities to increase the amount of physical, occupational, and speech therapy provided to meet pre-ordained Medicare revenue targets. The goals were unrelated to patients’ actual needs and could only be met by billing for therapy that was medically unnecessary.
The whistleblower in the Grace lawsuit will receive $405,000.
Medicare Fraud Brought to Light by Insider Heath Care Professionals
As in this case, the government is frequently notified of Medicare and Medicaid fraud by whistleblowers inside the health care provider’s operation. Before stepping forward, conscientious informants need to know their own rights. The experienced lawyers at Waters & Kraus give tipsters the aggressive representation they deserve in the battle against Medicare fraud. Contact us or call our health care fraud attorneys at 800.226.9880 to discuss how we can protect and advance your interests.