Whistleblowers Charge Life Care with Medicare Fraud By Tod Aronovitz | 12/04/12 | 0 Comment

Nursing home operator Life Care Centers of America, Inc. (“Life Care”) allegedly engaged in a “systematic scheme” to overcharge Medicare and TRICARE (a military health care program formerly known CHAMPUS), according to a whistleblower Medicare fraud lawsuit filed last week by the U.S. Department of Justice.

Life Care is a Cleveland-based company operating more than 200 skilled nursing homes, assisted living, retirement, home care and Alzheimer’s centers in 28 states, including 24 facilities in Florida.

The U.S. lawsuit is brought under the False Claims Act (“FCA”). Cases under the FCA are also known as qui tam or whistleblower cases. The suit charges that Life Care established internal guidelines requiring the delivery of expensive skilled rehabilitation therapies—such as physical, occupational, or speech therapies—that were not medically reasonable or necessary.

More specifically, Life Care allegedly set and closely monitored adherence to excessive corporate goals for the provision of “Ultra High” patient therapies, which offer the highest level of allowable Medicare reimbursement rates, regardless of the patient’s medical condition. Additionally, Life Care also established length of stay targets for Medicare patients that closely paralleled the allowable time period for benefit coverage.

In a statement published on its website, Life Care reports “…Contrary to the government’s allegations, Life Care’s therapy programs improve patients’ conditions and their quality of life. This belief is supported by medical literature, studies, and Life Care’s first-hand experience in observing the progress of patients who receive high intensity therapy.”

Medicare Fraud and Whistleblowers

The case originated with whistleblower actions brought separately by two former Life Care employees, one a nurse and the other a Florida-based occupational therapist.

Healthcare professionals who work in a facility that is suspected of overcharging Medicare, or appears to be engaged in some other type of Medicare fraud, can work with a whistleblower attorney (also known as a qui tam lawyer) to bring charges.

By acting as a whistleblower in what is known as a qui tam lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

Whistleblower cases receive special confidential treatment from the courts during the early investigation period, until allegations can be verified. As happened in this case, charges typically become public only if and when the U.S. government finds sufficient cause and intervenes in the action.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami law firm of ARONOVITZ LAW routinely works with Miami whistleblowers to document fraud against the government. Click on the link to read more about our Miami Whistleblower / Qui Tam law firm services.

Contact Miami whistleblower attorney Tod Aronovitz for a confidential discussion of your potential Miami Medicare fraud case.