New attorney general, Justice policies could take steam out of False Claims Act cases
A new attorney general at the helm, plus possible policy changes on the horizon, could spell a slowdown in fraud accusations against providers.
False Claims Act
Preferred Care settles for $540,000 in whistleblower upcoding case
Nursing home chain Preferred Care agreed to settle False Claims Act charges for $540,000, the Department of Justice has announced.
Hospice accused of treating ineligible patients agrees to $1.2M False Claims settlement
A for-profit hospice company and its owner agreed to pay $1.2 million to resolve allegations that the company fraudulently billed Medicare and Medicaid for hospice services.
Judge relieves Consulate of $350M FCA verdict penalty
A federal judge erased a $347 million False Claims Act verdict against a rehab provider because the judge felt it was unlikely that government would have withheld payments even if it was aware of billing violations.
Judge erases $347 million verdict against nursing home company
A federal judge in Florida has tossed a $347 million False Claims Act verdict against a nursing home operator, saying there wasn’t evidence the government would have withheld payment if aware of the billing violations later brought by a whistleblower.
Hospice provider to pay record-setting $75 million false claims settlement
The nation’s largest for-profit hospice provider and its parent company have agreed to pay $75 million to settle allegations that it submitted false Medicare claims for hospice services, authorities said Monday.
Judge gives provider reprieve on $347 million penalty
A Florida-based provider has breathing room to appeal a $347 million judgment after a federal judge said the payment could force 183 facilities to collapse.
False Claims Act liability for poor quality of care
Not surprisingly, different federal courts have staked out different positions on the standard for liability under a worthless services complaint.
‘Extrapolation’ demonstrates False Claims Act liability in rehab
Recent FCA complaints have relied on a number of arguments to substantiate the submission of false claims for Medicare reimbursement: systematic upcoding to higher RUG levels due to corporate “pressure” on front line care providers; targeting therapy at or around RUG thresholds; increasing therapy during “look back” periods; and providing skilled therapy that was not required for improvement in functioning.
Self-reporting False Claims Act violation averts litigation
Long-term care providers would do well to know the lesson from one Pennsylvania continuing care facility, which averted costly litigation when it discovered and later reported irregularities of more than $1 million in Medicare claims.
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