Nursing Home Pays $10 Million Whistleblower Settlement under the False Claims Act (FCA) – Sometimes Ultra-High can Reach New Lows

May 15, 2020
Medicare on Money

Saber Healthcare Group LLC , a consortium of assisted living facilities in seven states, has agreed to reimburse the taxpayers of the United States $10 million for alleged violations under the False Claims Act (“FCA”).  It was alleged that Saber’s skilled nursing facilities (SNFs) submitted false claims to Medicare for unreasonable, unnecessary services. 

According to Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division, “Patients are entitled to individualized healthcare services appropriate to their specific medical needs, when skilled nursing facilities provide rehabilitation therapy services based on maximizing revenue rather than what is necessary for their patients, we will not hesitate to hold them accountable.”

The allegations were that Saber engaged in a systemic practice of inflating its bills to Medicare in many different manners.  Skilled nursing facilities are reimbursed at a rate reflecting the therapy and nursing needs of qualified patients, with the reimbursement being commensurate with the degree of needs and services provided to the patients. “Ultra High” patients are  the ultimate level of Medicare reimbursement for patients who require a minimum of twelve hours of skilled therapy from two therapy disciplines, which at least one of them has to be provided five days a week.  For example, some skilled therapies are for things like physical therapy, occupational therapy, or speech therapy.

It was  alleged that Saber established, regardless of actual need, that all patients were provided with Ultra High therapy, pressured facility directors to compel therapists to bill for Ultra High therapy to each patient, prevented therapists from providing lower levels of therapy minutes even if warranted, pressured therapists to falsely report initial evaluation time as therapy time, and reported time spent providing unskilled services as skilled therapy.

Under the provisions of the False Claims Act, whistleblowers, also known as relators, can obtain a whistleblower award from the funds actually recovered from the qui tam lawsuit.  There were multiple whistleblowers in the Saber action who collectively will share in a $1.75 million dollar award or 17.5% of the recovery for the government. 

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According to noted whistleblower lawyer Jason T. Brown of Brown, LLC, “This is another excellent settlement showing the government intends to hold accountable entities who continue to and systemically overbill the government at the expense of the taxpayer.  I commend the work of all the lawyers involved, Paul Lawrence, Jeff Newman and Charles Siegel, who represented the relators, the United States Attorney’s Office, the Department of Justice, and of course the courage and integrity of the whistleblowers who came forward to expose this alleged fraud.”

The whistleblower law firm of Brown, LLC led by a former FBI Special Agent offers free confidential consultations to whistleblowers nationwide and dedicates a portion of their practice to protecting whistleblowers.  Some of the best whistleblower lawyers in the country continue to vigilantly work up these cases despite COVID impacted challenges and Brown, LLC continues to fully function to handle inquiries in times of need.

The case is captioned United States ex rel. Wright et al. v. Saber Healthcare Holdings, LLC et al., Case No. 2:16-cv-640 (E.D. Va.).  The claims resolved by the settlement are allegations only, and there has been no determination of liability.