Gov’t Intervenes in Nursing Home Medicare Fraud Case
The U.S. Department of Justice intervened in a Medicare fraud case initially filed by three former employees-turned-whistleblowers. The government seeks to recover millions of dollars allegedly paid to SavaSeniorCare, a large nursing home operator. According to the complaint, Sava operates approximately 200 facilities scattered in 23 states.
The complaints were filed over several years. Because Medicare fraud cases filed under the False Claims Act are filed under seal, the three co-workers were probably unaware of each other complaints. The three whistleblowers include a former director of social services in Tennessee, a former rehabilitation manager in Pleasanton, Texas and a social worker who once worked at Sava’s Houston facility.
Under the False Claims Act, a whistleblower is entitled to receive up to 30% of whatever the government collects from the wrongdoer.
Although each complaint has different facts, the three all allege a Medicare fraud scheme in which managers were given unrealistic financial goals. Prosecutors say the only way to meet those goals was to provide “medically unreasonable, unnecessary and unskilled services” that could be falsely billed to the Medicare program. In a prepared statement, a DOJ spokesperson said, “The provision of Medicare benefits must be dictated by patient need, not by Medicare providers’ efforts to maximize profits by pressuring their employees to provide medically unnecessary services.”
In addition to medically unnecessary services, the complaints say that Sava would delay discharging patients even if their condition warranted release. The goal was to prolong Medicare billings.
At times Sava owned facilities would waive Medicare copayments in an attempt to keep patients from leaving. (Waiving copayments is a violation of the federal Anti Kickback Statute and can be the basis of a False Claims Act claim.)
According to one of the complaints, an employee told the facility administrator, “’You know, Nicki [Ms. McCaleb], I don’t look good in orange,’ referring to the color of prison uniforms. All of the attendees at these meetings knew that McCaleb was asking them to falsify medical records, and Medicare/ Medicaid records, claims, and submissions.”
Although the complaints were filed some time ago, they were just unsealed after the government decided it would intervene. Sava has not yet been required to file an answer to the complaints.
Medicare fraud complaints filed by whistleblowers remain under seal (secret) while being investigated by the government. The statute gives the government just 60 days to investigate but judges routinely extend that time period for months and sometimes years.
In addition to the alleged Medicare fraud, the whistleblowers claim that employees who did not go along with the scheme were harassed or threatened with termination. The False Claims Act contains strong anti-retaliation provisions to protect whistleblowers that step forward.
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For more information, contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct). (You can also click here for more information about Medicare and Medicaid fraud.) All inquiries are always kept strictly confidential.
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