Therapy upcoding case brings $347 million judgment against Consulate

The judgment is triple the $115 million jury verdict reached in February, due to provisions of the FCA.
The judgment is triple the $115 million jury verdict reached in February, due to provisions of the FCA.

Skilled nursing chain Consulate Health Care has been hit with a $347 million judgment in a whistleblower case alleging that it routinely submitted false Medicare and Medicaid claims.

The judgment, reached Wednesday in the U.S. District Court for the Middle District of Florida, comes after a Feb. 15 verdict in which the jury sided with whistleblower Angela Ruckh, who worked for the provider when it was known as La Vie Rehab. She filed a lawsuit in 2011 claiming Consulate spent years conducting a “corporate scheme to bilk Medicare and Medicaid” by inflating therapy claims.

The case was notable for its use of the controversial method of statistical sampling, which a judge allowed Ruckh to use in her claims against Consulate in 2015.

The jury's verdict called for $115 million in Medicare and Medicaid damages. Wednesday's judgment triples that amount under provisions of the False Claims Act, and it adds the minimum penalty of $5,500 for the 446 cited false claims.

Consulate will have to pay $331 million of the total judgment, Bloomberg BNA reported. Ruckh's portion of the settlement is expected to be “substantial,” Bloomberg added, since FCA whistleblowers typically receive 15% to 25% of the total recovery.

A spokeswoman for Consulate told McKnight's on Thursday that the company is not commenting on the judgment at this time.