(This blog was written by whistleblower Investigator Lee Walters.)
In a scheme we’ve seen many times over the past five years or so, the United States Department of Justice announced yesterday, April 14, 2020, a $10 million settlement with Saber Healthcare Group, LLC (Saber) for violations of the False Claims Act. The settlement resolved allegations that Saber submitted false claims for rehabilitation therapy in its skilled nursing facilities (SNFs) that the company operated in four states (Virginia, Pennsylvania, Ohio and North Carolina).
The scheme, which is neither new nor unique, operates like this. Medicare reimburses SNFs at a daily rate that reflects the therapy and nursing needs of Medicare beneficiaries. The greater the patient’s needs, the higher level of Medicare reimbursement. The highest level of Medicare reimbursement is known as “Ultra High” which can be the golden ticket for unscrupulous providers. In this particular case, the United States alleged that Saber set goals that all patients should be provided therapy at the Ultra High level whether they needed the therapy or not. In past cases, we’ve seen Medicare patients who were bedridden and unresponsive “provided” Ultra High therapy when it was not even possible for them to participate in any kind of therapy. Saber, according to the government, pressured facility directors to ensure therapists provided the Ultra High level of therapy whether their professional judgment thought it necessary or not.
This Qui tam was brought forward by three brave whistleblower, all former therapists and managers of Saber, who will be receiving $1,750,000 from the settlement between the government and Saber under the provisions of the False Claims Act that allows the government to pay 15 – 30% rewards to whistleblowers.
If you’re aware of an SNF involved in a therapy billing scheme, or any other scheme where Medicare or Medicaid is paying for services that patients don’t need, or don’t actually receive, our whistleblower team at Morgan & Morgan would love to talk with you. There’s no obligation, no cost to you, and all conversations with us are strictly confidential.
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