Federal Government Seeks Millions In Reimbursements, Treble Damages, From Life Care Centers Of America

Friday, November 30, 2012

The federal government is seeking millions of dollars in reimbursements, plus treble damages, against Cleveland, Tn.,-based Life Care Centers of America as a result of two whistle blower lawsuits filed in federal court in Chattanooga in 2008.

The government intervened in the case overseen by Judge Sandy Mattice. The complaint was unsealed on Friday.

The suit says the government "brings this False Claims Act ("FCA") action against Life Care Centers of America, Inc.

("Life Care") to recover millions of dollars that Life Care caused the Medicare and TRICARE programs to pay for services that were not covered by the skilled nursing facility benefit, that were not medically reasonable and necessary, and that were not skilled in nature."

It says, "Medicare pays nursing facilities a daily rate to provide skilled nursing and skilled rehabilitation therapy services to qualifying Medicare patients (or "beneficiaries"). The daily rate that Medicare pays a nursing facility depends heavily on the rehabilitation needs of the beneficiaries. The highest daily rate that Medicare will pay a nursing facility is reserved for those beneficiaries that require "Ultra High" levels of skilled rehabilitation therapy, or a minimum of720 minutes per week of skilled therapy from at least two therapy disciplines  (e.g., physical, occupational, and speech). The Ultra High therapy level is intended for the most clinically complex patients who require rehabilitative therapy well beyond the average amount of service time. TRICARE pays nursing facilities using the same system as Medicare. 

"From at least 2006 to the present, Life Care, a large nursing home operator, engaged in a systematic scheme to maximize the number of days it billed to Medicare and TRICARE at the Ultra High level. Life Care accomplished this by setting aggressive Ultra Highrelated targets that were completely unrelated to its beneficiaries' actual conditions, diagnoses, or needs. Life Care then reinforced those targets at corporate meetings and presentations, through regular emails from or visits by corporate personnel, through employee performance evaluations, by imposing action plans on underperforming facilities, and various other means. While Life Care punished those facilities and employees that failed to meet its Ultra High targets or that complained about corporate pressure, it rewarded and applauded those that met its targets. As part of its goal to maximize Medicare and TRICARE payments, Life Care also frequently overrode or ignored the recommendations of its own therapists and unnecessarily delayed discharging beneficiaries from its facilities.

"As a direct result of Life Care's corporate pressure to maximize its Ultra harmful. Moreover, instead of providing skilled rehabilitation therapy that was tailored to beneficiaries' particular needs, Life Care therapists routinely provided generic, nonindividualized services that did not (and could not) benefit the beneficiaries and that served primarily to inflate what Life Care billed Medicare and TRICARE for those beneficiaries.

"Although Life Care received numerous complaints, from both inside and outside the company, that its corporate pressure to meet Ultra High targets was undermining the clinical judgment of its therapists at the expense of nursing home patients, Life Care largely ignored those complaints or else chastised or punished those who had complained.

"Life Care's corporate strategy and pressure succeeded in significantly increasing the number of days it billed at the Ultra High level and therefore inflating the money it received from Medicare and TRICARE. By 2008, for example, Life Care billed nearly 68 percent of its Medicare rehabilitation days at the Ultra High level-a level far in excess of the nationwide Ultra High average of 35 percent among all skilled nursing facilities during that same year.

"Because Life Care knowingly submitted false claims to the Medicare and TRICARE programs for medically unreasonable, unnecessary and unskilled therapy services, and used false records and statements to support those false claims, the United States brings this action to recover treble damages and civil penalties under the False Claims Act nd to recover damages and other monetary relief under the common law or equitable theories of unjust enrichment, disgorgement, and payment by mistake."

 One complaint was brought by Glenda Martin, a registered nurse and a former staff development coordinator of Life Care Center of Morristown, Tn.

 Another was by Tammie Taylor, a former occupational therapist of Life Care Center at Inverrary, in Lauderhill, Fla.

 

 

 

 

 

 

 

 


East Ridge Council Amends Budget; Revenues Up

The 2015-2016 fiscal year budget was amended at the East Ridge City Council meeting Thursday night to appropriate enough money to cover expenses. This is done periodically throughout the year. Since the last time the budget was amended, additional expenses that need to be added include repairs to a diesel pump to fuel the city’s diesel vehicles, overtime paid to employees at Camp ... (click for more)

Latest Hamilton County Jail Booking Report

Here is the latest jail booking report from Hamilton County: AKRIDGE, ANTONIO MARCELLOUS  1521 HICKORY VALLEY RD APT 505 CHATTANOOGA, 37421  Age at Arrest: 26 years old Arresting Agency: Hamilton County VIOLATION OF PROBATION (CRIMINAL TRESPASSING) --- ALLEN, DEQUISHA LASHALLE  1246 CYPRESS STREET COURT CHATTANOOGA, 37402  Age at Arrest: 26 ... (click for more)

Case Handled Like Any Other? - And Response

It is interesting that Chief Fletcher would deem the handling of the Mayor's encounter as typical or normal. Is the Chief asking the public to believe that all misdemeanor domestic violence arrests include a 4-hour taped interrogation, and delayed reporting after a visit to the Chief’s house. Of course, we believe that Chief Fletcher. April Eidson * * *  I ... (click for more)

Roy Exum: A Judge's Night Behind Bars

There is very little doubt that retired Army Sergeant Joe Serna has Post Traumatic Stress Disorder (PTSD) after serving three tours as a Green Beret in Afghanistan. Once he barely avoided being blown up by a hidden IED and then there was another terrifying brush with a suicide bomber. But the worst was when a truck he was in slid off the roadway into a canal. “It was like ... (click for more)

Peterson's Emotional Race Helps Signal Mountain Win

MURFREESBORO – It’s one thing to win one state championship in track.  It becomes a tougher challenge to repeat and at times impossible to even think about a three-peat. But that’s what the Signal Mountain Lady Eagles did here at the Dean A. Hayes Track & Soccer Stadium on the campus of Middle Tennessee State University early Thursday evening. Signal Mountain ... (click for more)

Baylor Rocks GPS, 8-2, For Shot At 10th State Softball Championship

MURFREESBORO, Tenn. – The magic number Baylor’s softball team has in mind now is 10. After polishing off bitter rival Girls Preparatory School – a seemingly constant opponent at TSSAA’s Spring Fling – by 8-2 Thursday in the Division II-AA winner’s bracket final, the Lady Red Raiders are zeroed in on a game that could produce their 10 th  state championship.  “It ... (click for more)