July 12, 2020

Volume X, Number 194

July 10, 2020

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July 09, 2020

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Nursing Home’s Rehabilitative Services Chain Settles False Claims Allegations for Ten Million Dollars

Saber Healthcare Group, LLC and other entities have agreed to pay the U.S. government a settlement of  $10 million to resolve alleged “false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary, or skilled,” the Justice Department reported.

Saber Healthcare offered patients multiple levels of Rehabilitation Therapy. The highest level of prescribed patient therapy is labeled “Ultra High” for patients “who require a minimum of 720 minutes of skilled therapy from two therapy disciplines,” and is Medicare’s most expensive level of therapy. The whistleblower complaint alleges that Saber knowingly and “improperly established general goals that all patients should be provided with the Ultra High level of therapy, regardless of the patients’ individual therapeutic needs, and enforced that expectation by pressuring therapists to provide Ultra High therapy to patients at nine facilities.” As a healthcare provider, Saber’s therapeutic services are eligible for federal reimbursement, with “Ultra High” Rehabilitative Services reimbursed at a much higher rate than other forms of therapy. By allegedly forcing Saber staff to prescribe and perform unnecessary “Ultra High” therapies on patients so that Saber could receive larger payments from Medicare, Saber directly violated the False Claims Act.

In the case against Saber, whistleblowers and former Saber employees Hope Wright, Laura Webb, and Deborah Edmonds were the whistleblowers who brought forward the qui tam (whistleblower) lawsuit against the company. Private citizens can bring qui tam lawsuits under the False Claims Act, which allows them to act on behalf of the U.S. government to expose the fraud against the government. Under the FCA, whistleblowers receive a portion of the money that has been recovered by the government called the relator’s share. “Wright, Webb, and Edmonds will receive $1,750,000 from the settlement with Saber.”

Unscrupulous healthcare companies have found many different ways to take advantage of vital government programs like Medicare. The False Claims Act has been an essential weapon in the fight against government programs fraud.

© 2020 by Tycko & Zavareei LLPNational Law Review, Volume X, Number 181

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About this Author

Jonathan K. Tycko leads the Whistleblower Practice Group of Tycko & Zavareei LLP

In recent years, the laws of the United States have undergone a whistleblower revolution. Federal and state governments now offer substantial monetary awards to individuals who come forward with information about fraud on government programs, tax fraud, securities fraud, and fraud involving the banking industry. Whistleblowers also now have important legal protections, designed to prevent retaliation and blacklisting.

The law firm of Tycko & Zavareei LLP works on the cutting edge of this whistleblower revolution, taking on even the most complex and confidential whistleblower...

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