Archive for October, 2016

Skilled Nursing Company to Pay $145 Million to Resolve False Claims Act Case

Whistleblower Case

Whistleblower CaseOn October 24, 2016, the Department of Justice announced a settlement with Life Care Centers of America Inc. (Life Care) and its owner, Forrest L. Preston. The defendants agreed to pay $145 million to resolve a lawsuit alleging that Life Care violated the False Claims Act (FCA) by knowingly causing skilled nursing facilities (SNFs) to submit false claims to Medicare and TRICARE for rehabilitation therapy services that were not reasonable, necessary or skilled. Life Care, which is based in Cleveland, Tennessee, owns and operates more than 220 skilled nursing facilities across the United States.

“This resolution is the largest settlement with a skilled nursing facility chain in the department’s history,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “It is critically important that we protect the integrity of government health care programs by ensuring that services are provided based on clinical rather than financial considerations.”

The settlement resolves allegations that, between January 1, 2006 and February 28, 2013, Life Care submitted false claims for rehabilitation therapy by engaging in a systematic effort to increase its Medicare and TRICARE billings. Medicare reimburses SNFs at a daily rate that reflects the skilled therapy and nursing needs of qualifying patients. The greater the skilled therapy and nursing needs of the patient, the higher the level of Medicare reimbursement. The highest level of Medicare reimbursement for SNFs is for “Ultra High” patients who require a minimum of 720 minutes of skilled therapy from two therapy disciplines (e.g., physical, occupational, or speech), one of which must be provided five days per week.

In the complaint, the United States alleged that Life Care instituted corporate-wide policies and practices designed to place as many beneficiaries in the Ultra High reimbursement level regardless of the clinical needs of the patients, resulting in the provision of unreasonable and unnecessary therapy to many beneficiaries. Life Care also sought to keep patients longer than was necessary in order to continue billing for rehabilitation therapy, even after the treating therapists felt that therapy should be discontinued.

“The resolution announced today demonstrates the commitment of the U.S. Attorney’s Office to aggressively pursue providers who utilize fraudulent practices to knowingly put their own financial self-interest over a duty to patients,” said U.S. Attorney Wilfredo A. Ferrer of the Southern District of Florida. “It is imperative that providers make healthcare decisions based upon a patient’s need for services rather than a self-serving desire to maximize financial profit. Our office will continue to investigate fraud allegations, in order to ensure that providers do not compromise the integrity of our public health care programs.”

The settlement, which was based on the company’s ability to pay, is a great reminder that employees are given tremendous power under the FCA to rectify fiscal wrongdoing that they observe in the workplace. In this case, the whistleblower reward for filing their qui tam whistleblower lawsuit will be $29 million for relators Tammie Taylor and Glenda Martin.

 

Investigator Jim Ross Describes his Whistleblower Case Philosophy

James Hoyer Investigator Jim Ross made his name as an award winning investigative reporter who uncovered corruption and fraud. The Florida Attorney General’s office then benefited from Jim’s intense commitment and drive, as he continued his investigative work in the state’s Economic Crimes unit. Today, Jim uses his unmatched skills in interviewing witnesses and computer data and document analysis to develop whistleblower cases for the James Hoyer Law Firm.

Jim is guided by an an exemplary work ethic and a commitment to justice. Watch the video below to hear more about his background and the philosophy that makes him one of the firm’s greatest assets.

 

“Managed Repair” of Home Insurance Claims Wreaking Havoc for Homeowners

insuranceBotched repairs, improper mold remediation, additional damage to your home, and extensive delays in getting repairs done.  Those are just some of the problems becoming more and more common for homeowners subjected to “managed repair” by their home insurance companies.

Media Coverage

The James Hoyer Firm, along with attorneys from the Stockham Law Firm in Tampa, are teaming up to help homeowners being subjected to this burdensome practice.  Here are several recent cases where we helped to expose the problems of “managed repair” with local news media:

WPTV TV in West Palm: Homeowners concerned after Florida insurance companies manage repairs

WEAR TV in Pensacola: Homeowner blasts Right to Repair policy for insurance companies

WINK TV in Ft. Myers: Locked out of repairs: a clause that may impact your home insurance claim

WINK TV in Ft. Myers: Homeowner sues insurance company over alleged deceptive practices

WFTS TV in Tampa:  Another Managed Repair Nightmare

Several Florida home insurers have begun to invoke their “right to repair” clause when homeowners file a claim. Insurers will say it takes the hassle away from the homeowner, but as we’ve seen, it often causes more problems for homeowners, rather than fewer.

Right to Repair/Wrong for Homeowners

Essentially, the insurance company takes over the repair of your property when you make a claim, instead of paying you the amount to get the work done with a contractor of your choice. This saves the insurance company money by using one of its “preferred contractors,” but has led to contractors cutting corners, rushing jobs, or creating lengthy delays in completing work.  The homeowner often does not know how much the contractor gets paid or what exactly their deal is with the insurer. The repair of your home is literally hijacked.  It takes away much of the control over who does the work and how it’s done in your own home.

To learn more about this and what you can do about it click here.