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The Department of Justice (DOJ) has announced yet another nursing home fraud settlement. Last month, Saber Healthcare Group LLC (and related entities) agreed to pay $10 million to resolve a whistleblower lawsuit. The suit (joined by the government for settlement) argued that, for years, Saber charged Medicare for rehabilitation therapy services that were not reasonable or necessary. The government also alleged that therapists often provided basic nursing services, but billed the taxpayers for more expensive “skilled” therapy. This settlement resolves allegations at nine different Saber nursing facilities.
Saber, which owns and operates facilities in seven states, is the latest skilled nursing facility (SNF) chain to find itself across the table from DOJ. In recent years, DOJ has settled numerous matters with companies accused of subjecting seniors to unnecessary therapy services to maximize their revenue. This includes suits and settlements against LifeCare Centers for America, Genesis Healthcare, Kindred Healthcare, Guardian Elder Care, and others. These matters have already recovered hundreds of millions of dollars for the Medicare and Medicaid systems. In fact, the fraud and harm was so well-documented that the government has even changed how it pays for this type of therapy. The change was enacted to reduce the financial incentive for facilities to over-treat residents, among other things.
The allegations against Saber repeat an all too common tale: Residents being placed into intensive therapy regimens even when they cannot tolerate it. Therapists prevented from adjusting the treatment program to fit the needs and capabilities of their patients. Executives instructing therapists to falsify their billing records in myriad ways.
This behavior harms far more than the public fisc. Lawsuit after lawsuit share gut-wrenching examples of patients being forced to undergo physical therapy that they simply could not tolerate and/or did not want. These include instances of patients receiving intensive therapy just days or hours before passing away; patients being forced to complete over an hour of therapy immediately after undergoing exhausting dialysis treatments; and persons with dementia being easy targets for such schemes. Examples such as these are surely behind the DOJ’s ongoing focus on nursing home therapy fraud. And no doubt they have influenced DOJ’s National Nursing Home Initiative, announced this past March.
DOJ’s new initiative goes well beyond therapy. It targets the problem of grossly substandard care in many homes around the country. As detailed in the announcement, DOJ will be looking carefully at “nursing homes that consistently fail to provide adequate nursing staff to care for their residents, fail to adhere to basic protocols of hygiene and infection control, fail to provide their residents with enough food to eat so that they become emaciated and weak, withhold pain medication, or use physical or chemical restraints to restrain or otherwise sedate their residents.” With COVID-19 causing devastation in nursing homes nationwide, there is little doubt that DOJ and state attorneys general will be taking a very close look at these very issues for the weeks, months, and years to come.