The Federal Government is seeking to recoup millions of dollars paid to Life Care Centers of America, a large nursing home operator, who engaged in a systematic fraud scheme resulting in millions of dollars in false claims billed to Medicare and TRICARE, (TRICARE is the health care program for military personnel & retirees.) It is alleged that Life Care systematically billed at the Ultra High Level for services not covered by the skilled nursing facility benefit and that were not medically reasonable and necessary.
To bill at the Ultra High Level means that the federal government pays Medicare and TRICARE beneficiaries the highest daily rate possible. The daily rate is accorded to the level of care they need, and the Ultra High level means those beneficiaries require a minimum of 720 minutes per week.
According to recent filings, from at least 2006 until the present, Life Care Centers of America created and executed a scheme to bill Medicare and TRICARE at the Ultra High Level by setting aggressive quotas that were completely unrelated to its beneficiaries’ actual needs. According to the complaint, Life Care then reinforced those targets at corporate meetings, and through regular emails and visits by corporate personnel. While Life Care punished those facilities and employees that failed to meet its quotas or that complained about corporate pressure, it rewarded those that met their goals. As part of its scheme to maximize Medicare and TRICARE payments, Life Care also frequently nullified the recommendations of its own therapists and unnecessarily kept beneficiaries in their facilities longer than their care plan required.
According to the complaint, Life Care knowingly submitted false claims to the Medicare and TRICARE programs for medically unreasonable, unnecessary and unskilled therapy services, and used false records to support those false claims. There have been several complaints from inside and outside the company that Life Care largely ignored.
By 2008, the company was billing 68% of its Medicare rehabilitation days at the Ultra High Level—far greater than the national average of 35% among all rehabilitation facilities during that same year.
The complaint comes a month after the U.S. Department of Health and Human Services reported that Medicare loses roughly $1.5 billion each year from false claims.
Source :”Federal Government Seeks Millions In Reimbursements, Treble Damages, From Life Care Centers Of America” The Chattanoogan.com