SNFs should expect more 'worthless services' whistleblower charges, expert says

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Skilled nursing facilities soon might be facing an onslaught of whistleblower lawsuits alleging “worthless services,” a legal expert cautioned Tuesday.

Attorney Ari J. Markenson warned providers of the brewing threat at the American Health Lawyers Association's Fraud and Compliance Forum, Bloomberg BNA reported.* He said that suits of this type often originate from within, when a nurse or other caregiver does not think an organization is responsive to concerns or problems and becomes a whistleblower.

Recent comments from Leslie Caldwell, assistant attorney general for the Department of Justice's Criminal Division, also indicate the government will be increasingly aggressive about intervening in these types of lawsuits, Markenson said.

Courts have not definitely settled how bad care has to be in order to qualify as “worthless.”

In one ongoing case, a federal judge in Mississippi rejected a provider's argument that a bundle of billed-for services has to have no value at all to support a worthless services charge. If this were the case, then nursing homes could receive Medicare and Medicaid reimbursement for simply providing squalid shelter and “bread and water” for survival, wrote District Judge Carlton W. Reeves of the Southern District of Mississippi.

*Editor's Note: A previous version of this article referred to this news source as the Bureau of National Affairs. It has not gone by this name since 2011.