Federal Government Seeks Millions In Reimbursements, Treble Damages,...

Dec 1, 2012 Full story: Chattanoogan.com 21

The federal government is seeking millions of dollars in reimbursements, plus treble damages, against Cleveland, Tn., based Life Care Centers of America as a result of two whistle blower lawsuits filed in federal court in Chattanooga in 2008.

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Medicare 855

United States

#1 Dec 2, 2012
What great news this is Forrest had hid behind people and brain washed them in every way possible to believe that stealing from the government is ok in the healthcare business.
Michael

Cleveland, TN

#4 Dec 4, 2012
Michael
We Are Not.A Jury

Duluth, GA

#5 Dec 4, 2012
Let the Judge and Jury make the determination of innocent or guilty. Until all evidence is brought forward no one is in anyplace to Judge this organization.
$400 Club

Duluth, GA

#6 Dec 6, 2012
Looks like some them mofo's will be going to jail over 4 bills - some stupid a-- therapist
dennis matthews

Cleveland, TN

#7 Dec 12, 2012
Whoa now. Isn't carrying a patient 50 feet walking therapy?
PT Aide

Morristown, TN

#8 Dec 12, 2012
dennis matthews wrote:
Whoa now. Isn't carrying a patient 50 feet walking therapy?
Yep for the therapist it is, for the facility its $500.00 or above for ultra high and for the poor little old person its called abuse!!!
dennis matthews

Cleveland, TN

#9 Dec 13, 2012
I know PT Aide. How well I know.
Campus Employee

Duluth, GA

#10 Dec 17, 2012
I feel so bad for the patients who were a used. The 81 year old who died shortly after therapy or the gentlemen who hadn't walked in years but forced to try stand up so the home could bill for him. God I hope that big old house ends up a retreat for homeless children. We all cross our fingers every day hoping we are not questioned cause we will not lie. Thanks for listening
PT Aide

Morristown, TN

#11 Dec 21, 2012
In light of the big Government fraud case the company has they give themselves a big bunch of awards for their therapy habits! Yeah! Now that takes balls LOL
Doubtful

United States

#12 Dec 21, 2012
I doubt the accuracy of that.
Problems Run Deep

Duluth, GA

#13 Dec 21, 2012
We only have scratched the surface of the deceptive practices. Personal Lear Jet Pilot fired for sexual harassment. Director of travel brings sexual harassment charges against company Dr Scott's secretary brings charged the company is on a downhill sled
PT Aide

Morristown, TN

#14 Dec 22, 2012
you talking Life Care or all corporate corruption?
PT Aide

Morristown, TN

#15 Dec 22, 2012
[QUOTE who="We Are Not.A Jury"]Let the Judge and Jury make the determination of innocent or guilty. Until all evidence is brought forward no one is in anyplace to Judge this organization
By Todd South and Kate Harrison
The Chattanooga Times Free Press
updated 12/15/2012 10:19:28 PM ET
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Chattanooga, Tenn. Details of an ongoing federal investigation into Life Care Centers of America reveal claims that elderly patients undergoing end-of-life care at several company facilities were pushed to high levels of unnecessary therapies so the company could bill maximum Medicare amounts for profit.
The examples in the federal complaint show a more personal side to the allegations of corporate-encouraged fraud that prosecutors have leveled against the Cleveland, Tenn.-based company.
One segment details the case of "Patient D," a 92-year-old resident at a Life Care facility in Orlando, Fla., who was dying of melanoma in 2007. Though the cancer had spread to Patient D's brain and lungs and radiation treatments had made him "medically fragile," he still was administered two hours of therapy every day.
Two days before Patient D died, he was spitting out blood. Yet therapists recorded 48 minutes of physical therapy, 47 minutes of occupational therapy and 30 minutes of speech therapy in one day.
"The day Patient D died, Life Care therapists recorded 35 minutes of physical therapy and had him scheduled for occupational therapy later in the day," court records state.
Other cases described in court records include:
n Patient C: An "extremely frail" 80-year-old female resident of the company's center in Columbia, S.C., in March 2006 was "very lethargic, hard to arouse" and "required assistance to control her head and to open her eyes." But therapists placed her in a standing frame -- equipment that holds the patient in a standing position -- supporting areas too weak to remain standing. Both the physical and occupational therapists recorded 42 minutes each for the time Patient C spent standing in the frame. The woman died five days later.
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n Patient I: A 62-year-old male resident at the Columbia, S.C., center could not walk and was "totally dependent" for "bed mobility, transfers, toilet use and bathing." Life Care billed Medicare for "standing exercises" at the highest level allowed from April until June 2007.
n Patient A: A 78-year-old male patient at the company's Park View Care Center in Indiana was "frail and debilitated" when admitted in early May 2008. Therapists "subjected him" to more than 13 hours of physical, occupational and speech therapies in his first week at the location. Later that month Patient A was admitted to the hospital, then returned to the Life Care facility on May 28 for palliative care. Instead, therapists provided nearly five hours of therapy on May 31 and June 1. Patient A died on June 2, 2008
tion.[/QUOTE]
Yes I agree......You are 100% right of course.
Reading

Dandridge, TN

#17 Jan 25, 2013
This is all very disturbing and if true criminal. There needs to be criminal charges. It sounds like a very harmful scam to fleece the government and steal money. This company sounds very greedy but hey dudes leave the weak, sick and vulnerable out of it man. You suck!
unreal

Morristown, TN

#18 Jan 31, 2013
Life Care Centers of America, headquartered in Cleveland, Tenn.
Photo by Jenna Walker /Chattanooga Times Free Press.
THE STORY SO FAR
In 2008 two former employees in separate cases filed whistle-blower lawsuits alleging that Life Care Centers of America was providing excessive therapies to Medicare patients to increase reimbursements.
Both lawsuits have been consolidated and had remained sealed with closed hearings until the Chattanooga Times Free Press requested the files and hearings be opened in September. U.S. District Judge Harry S. "Sandy" Mattice agreed to open the case in November.
Life Care has more than 200 facilities in 28 states with 38,000 employees and $2.69 billion in annual revenue, according to a 2011 Forbes.com report.
From 2006 until 2011 the company received $4.2 billion in Medicare reimbursements, according to court documents.
Source: Federal court documents
Federal prosecutors allege that a widespread Medicare fraud scheme at Life Care Centers of America began at the highest levels of the corporate hierarchy and that employees who complained about possibly illegal practices were "ignored," "chastised," "punished" or fired.
Recently unsealed court records in an ongoing whistle-blower lawsuit against the Cleveland, Tenn.-based company reveal claims that the company founder and sole shareholder, Forrest Preston, forbade his own compliance department from conducting unannounced inspections at facilities.
Prosecutors claim that former Chief Operating Officer Cathy Murray circumvented the department's responses to employee complaints while she "aggressively drove the company's push for increased Medicare revenue."
"As [Murray] frequently told her employees,'their job was to make money for Forrest Preston,'" according to court documents.
Murray could not be reached for comment Friday.
If found guilty on the fraud charges, Life Care could face fines in the hundreds of millions of dollars. Each fraudulent report carries a $5,000 to $11,000 fine, and prosecutors have asked the judge to triple the damages.
Company representatives have declined to comment on the allegations and referred questions to a Nov. 30 letter issued after the lawsuit became public.
"Contrary to the government's allegations, Life Care's therapy programs improve patients' conditions and their quality of life," the statement reads. "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."
unreal

Morristown, TN

#19 Jan 31, 2013
Life Care is the nation's largest private nursing home company with more than 200 facilities in 28 states. From 2006 to 2011 Life Care received $4.2 billion in Medicare reimbursements.
Joe Carcello, director of research for the University of Tennessee's Corporate Governance Center, said management practices for private health care companies are similar to other for-profits but differ in some important ways.
Carcello likened increasing revenues for many businesses to someone shopping at the mall. A salesperson at a clothing store may sell a customer more clothes than he or she needs, but there's no ethical obligation on the staff -- the customers are responsible for their purchasing decisions.
Not so with Medicare.
"The payer for this is not the patient; the payer for this is the federal government," Carcello said. "In health care there are ethical obligations established by medical ethics embedded in state law and medical licensing codes that require medical care to be performed in the best interest of the patient."
The beginning
In 2005, Preston, Murray and Michael Reams, senior vice president of Rehabilitation Services, formed the "Rehabilitation Opportunity Committee" to increase Medicare revenues through higher therapy treatment levels and more days spent in their facilities, according to court documents.
Medicare reimburses therapies for patients in the first 100 days of care at five levels. Ultra High is the highest level and can pay a provider as much as $564. The lowest rate of therapy pays $231.
Prosecutors allege that companywide fraud began as early as 2006 and persisted until at least 2011. By 2008 Life Care was billing 68 percent of its Medicare therapies at the Ultra High level, nearly twice the national average of 35 percent, according to court documents.
unreal

Morristown, TN

#20 Jan 31, 2013
Federal prosecutors allege that a widespread Medicare fraud scheme at Life Care Centers of America began at the highest levels of the corporate hierarchy and that employees who complained about possibly illegal practices were "ignored," "chastised," "punished" or fired.

Recently unsealed court records in an ongoing whistle-blower lawsuit against the Cleveland, Tenn.-based company reveal claims that the company founder and sole shareholder, Forrest Preston, forbade his own compliance department from conducting unannounced inspections at facilities.

Prosecutors claim that former Chief Operating Officer Cathy Murray circumvented the department's responses to employee complaints while she "aggressively drove the company's push for increased Medicare revenue."

"As [Murray] frequently told her employees,'their job was to make money for Forrest Preston,'" according to court documents.

Murray could not be reached for comment Friday.

If found guilty on the fraud charges, Life Care could face fines in the hundreds of millions of dollars. Each fraudulent report carries a $5,000 to $11,000 fine, and prosecutors have asked the judge to triple the damages.

Company representatives have declined to comment on the allegations and referred questions to a Nov. 30 letter issued after the lawsuit became public.
unreal

Morristown, TN

#21 Jan 31, 2013
In 2005, Preston, Murray and Michael Reams, senior vice president of Rehabilitation Services, formed the "Rehabilitation Opportunity Committee" to increase Medicare revenues through higher therapy treatment levels and more days spent in their facilities, according to court documents.

Medicare reimburses therapies for patients in the first 100 days of care at five levels. Ultra High is the highest level and can pay a provider as much as $564. The lowest rate of therapy pays $231.

Prosecutors allege that companywide fraud began as early as 2006 and persisted until at least 2011. By 2008 Life Care was billing 68 percent of its Medicare therapies at the Ultra High level, nearly twice the national average of 35 percent, according to court documents.

"Life Care set both these targets based solely on financial considerations and not on the individualized medical needs of its Medicare beneficiaries," prosecutors allege.

Reams directed regional managers to increase therapy rates and length of stay among the 29 regions he directed across the country, prosecutors say. Those directors oversaw therapy managers at individual facilities.

At each facility a therapy team, with workers trained in physical, occupational and speech therapy, provided the care for patients.

Facilities that did not have the rates corporate headquarters wanted were labeled "focus facilities" and began receiving quarterly visits from Reams' staff, monthly visits from divisional rehabilitation directors and weekly visits from regional rehabilitation directors.

unreal

Morristown, TN

#22 Jan 31, 2013
Carcello said going after employees who complained ran counter to the goals of the hotline and "speaks volumes about the mindset of senior management" of a company.
"Investigations frequently focused more on rooting out the complainant than investigating or addressing the problem identified in the complaint," prosecutors allege.
Rather than the compliance department investigating complaints, "the very Life Care employees responsible" for therapy targets and pressure, including Reams, conducted the investigations.
Carcello said, if true, not allowing compliance staff to conduct investigations is "extremely poor practice." He said that and not allowing unannounced inspections were "massive red flags."
"If you're told you can't look at something, often it means that you can't look at it because there's something to hide," Carcello said.
Other division heads frustrated and interfered with compliance department investigations, impeded access to data and pressured the department to close complaint cases, prosecutors say.
There are advantages and disadvantages to running a private company, Carcello said. With a private company such as Life Care decisions can be made more quickly, often more efficiently and outside of public scrutiny, especially media attention.
But public companies provide an advantage with a system of checks and balances. The board is usually made up of outsiders, and independent audit or compliance departments that report to the board are not as easily subject to pressures from other departments, he said.
"The process is designed to mitigate that risk because the people on the boards, audit committees, independent directors have a lot to lose if there's a fraud," he said.
Employee response
Some employees left the company rather than continue to work under the corporate pressure of increased therapies with questionable medical necessity, court documents show.
In May 2007 the rehabilitation manager of the Life Care center in Estero, Fla., quit her job and filed an email detailing her reasons for leaving.
"The therapists know what the patients can tolerate," she wrote. "Anyone who looks solely on the sheets and minutes has no idea why minutes are being missed.
"A patient could be sick or dying. Let me give an example of Mrs. S who we were made to put into a [therapy] category even after therapists who treated her told me she could not tolerate that level. She expired last Friday ... in front of the building while being taken to the doctor. I wonder if we had anything to do with hastening that process along," she wrote.
The entire Estero staff signed a letter sent to Reams that supported the director:
"Recently the financial goals of Life Care appear to have overshadowed the importance of complying with Life Care's own policy," the staff wrote.
A rehabilitation contractor at the company's Yuma, Ariz., facility terminated its contract because the contractor "believed that Life Care was asking therapists to provide unnecessary rehabilitation therapy designed primarily to increase Life Care revenue rather than meet patient needs," according to court documents.
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unreal

Morristown, TN

#23 Jan 31, 2013
Prosecutors say the regional rehabilitation directors told therapists to assign patients to the Ultra High level of therapy "regardless of diagnosis, physical ability or current health status."
The directors set the number of therapy minutes "sometimes over the express objections and recommendations of therapists. And directors pushed therapists to approach patients seven to eight times a day to meet the number of assigned minutes."
"Life Care employees viewed the program as an artificial means of extending a patient's length of stay," according to court documents.
Those who complained on the company's hotline sometimes faced retaliation.
"Although Life Care received numerous complaints from both inside and outside the company that its corporate pressure to meet Ultra High targets was undermining the clinical judgment of its therapists at the expense of nursing home patients, Life Care largely ignored those complaints or else chastised or punished those who complained," prosecutors allege.
Prosecutors claim that of those who gave their names in hotline complaints, 57 percent were fired within three weeks of making the complaint.

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