On June 11, 2018, the U.S. Department of Justice, U.S. Attorney’s Office for the Middle District of Tennessee announced that Signature HealthCARE, LLC (“Signature”) has agreed to pay more than $30 million to resolve allegations that it violated the False Claims Act by knowingly submitting false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary and skilled, and that it submitted forged pre-admission certifications of patient need for skilled nursing to the state of Tennessee’s Medicaid program.
Kentucky-based Signature, which owns and operates approximately 115 skilled nursing facilities, including seven in middle Tennessee, was alleged to have engaged in various practices that resulted in the submission of claims for unreasonable, unnecessary, and unskilled services to Medicare patients, including: presumptively placing patients in the highest therapy reimbursement level, rather than relying on individualized evaluations to determine the level of care most suitable for each patient’s clinical needs; providing the minimum number of minutes required to bill at a given reimbursement level while discouraging the provision of additional therapy beyond that minimum threshold; and, pressuring therapists and patients to complete the planned minutes of therapy even when patients were sick or declined to participate in therapy.
The settlement resolves a qui tam lawsuit (whistleblower lawsuit) that was filed by two former Signature therapy employees in federal court in Nashville, Tennessee. The federal government intervened in the federal lawsuit, and took over the litigation, pursuant to the False Claims Act. Pursuant to provisions in the False Claims Act, the two whistleblowers will share in a portion of the recovery.
The Special Agent in Charge for the U.S. Department of Health and Human Services, Office of Inspector General, stated in reference to the announced settlement, “Signature was charged with illegally boosting profits by providing excessive amounts of therapy to patients whether they needed it or not. The decision to provide therapy should never be based on corporate financial considerations rather than a patient’s medical needs.”
The U.S. Attorney involved in the matter stated, “Health care providers who engage in deceptive practices place patients at unnecessary risk and contribute to the financial distress of our federal healthcare programs. Our dedicated teams of civil enforcement attorneys will work tirelessly with the relators who report fraud such as this and with our law enforcement partners who investigate healthcare fraud. When we determine that companies are cheating the taxpayers, we will hold them accountable as we have in this case.”
The case is captioned United States ex rel. Emerson and Tuesca v. Signature HealthCARE, LLC, et al., Case No. 1:15-cv-00027 (M.D. Tenn.). The U.S. Attorney’s Office stated that the claims resolved by the settlement are allegations only, and there has been no determination of liability.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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