Simpson Law Firm, LLC

On October 24, 2016, the Department of Justice announced that Life Care Centers of America had agreed to pay $145 million to resolve two lawsuits alleging that Life Care knowingly caused its skilled nursing facilities to submit false claims to Medicare and Tricare for therapy that was not reasonable or necessary, in violation of the False Claims Act.  Life Care owns and operates more than 220 skilled nursing facilities throughout the United States.  Principal Deputy Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division, announced: “This resolution is the largest settlement with a skilled nursing facility chain in the department’s history. It is critically important that we protect the integrity of government health care programs by ensuring that services are provided based on clinical rather than financial considerations.”  

The settlement resolves allegations brought in two separate qui tam lawsuits filed by relators Glenda Martin and Tammie Taylor, former Life Care employees. Simpson Law Firm represents Ms. Martin.  The United States intervened in the two lawsuits, which were consolidated in federal court in Chattanooga. The two qui tam cases are docketed as United States ex rel. Martin v. Life Care Centers of America, Inc., No. 1:08-cv-251 (E.D. Tenn), and United States ex rel. Taylor v. Life Care Centers of America, Inc., No. 1:12-cv-64 (E.D. Tenn).  The two whisteblowers will receive a total of $29 million as a relator's share.

On May 28, 2015, a federal court in Colorado granted partial summary judgment to the relator in United States ex rel. Baker v. Banner Health, et al., Case No. 1:12-cv-3029 (D. Colo.), holding that  a nonphysician practitioner, such as an advanced practice nurse, cannot provide the required "direct supervision" of radiation therapy services for purposes of Medicare, since Colorado law only allows a qualified radiation oncologist to furnish such services.  Simpson Law Firm represents the relator in this case.

On August 21, 2014, the court entered partial summary judgment in favor of the relators in U.S. ex rel. Bartlett and Gummo v. Ashcroft, et al., Case No. 3:04-57 (W.D. Pa).  The court held as a matter of law that the physician defendants made referrals to Tyrone Hospital for designated health services in violation of the Stark Law, and that Tyrone Hospital received payment from Medicare for such services.

In two separate rulings, the federal judge overseeing the False Claims Act case against Life Care Centers of America has upheld the government's ability to use statistical sampling to prove the number and amount of false claims submitted by Life Care.  As explained in the decisions, the government proposed to select a random sample of 400 patients from 82 different Life Care facilities, and to perform a medical review of the claims submitted for such patients in order to determine whether the services were properly covered by Medicare or TRICARE.  The results would then be extrapolated in order to estimate the total number of claims submitted for non-covered services and the total loss associated with such claims.  

The court rejected Life Care's argument that the government must individually identify each separate claim that it alleges was false, holding that "the purpose of statistical sampling is precisely for these types of instances in which the number of claims makes it impracticable to identify and review each claim and statement."

The court noted the use of sampling was particularly appropriate in the Medicare context, stating that "those who commit fraud today have the aid of tools of technology and a relative unlikelihood of detection deriving from the sheer scale of the Medicare program itself.... Given the large number of claims that can be submitted by a single entity to be reimbursed by Medicare, it is often not practicable to do a claim-by-claim review of each allegedly false claim in a complex FCA action. "

Simpson Law Firm represents one of the two relators in the consolidated cases.

Amedisys, Inc., one of the country's largest home health providers, has agreed to pay $150 million to resolve allegations of health care fraud asserted in seven different qui tam lawsuits pending in Pennsylvania and Georgia.  

As stated in the government's press release, "Amedisys allegedly billed Medicare for nursing and therapy services that were medically unnecessary or provided to patients who were not homebound, and otherwise misrepresented patients’ conditions to increase its Medicare payments. These billing violations were the alleged result of management pressure on nurses and therapists to provide care based on the financial benefits to Amedisys, rather than the needs of patients."  In addition, the government "alleged that Amedisys’ financial relationship with a private oncology practice in Georgia – whereby Amedisys employees provided patient care coordination services to the oncology practice at below-market prices – violated statutory requirements."

Simpson Law Firm represents the relators in two of the lawsuits.

The United States has intervened in two lawsuits against Life Care Centers of America, one of the largest nursing home operators in the country, and has consolidated the two cases in federal court in Chattanooga.  In its consolidated complaint, the United States alleges that Life Care engaged in a systematic scheme to maximize the number of days it billed Medicare and TRICARE for therapy services at the "Ultra High" level, which results in the highest payment.  The United States alleges that "Life Care accomplished this by setting aggressive Ultra High-related targets that were completely unrelated to its beneficiaries' actual conditions, diagnoses, or needs."  The complaint alleges that "[a]s part of its goal to maximize Medicare and TRICARE payments, Life Care also frequently overrode or ignored the recommendations of its own therapists and unnecessarily delayed discharging beneficiaries from its facilities."

The complaint alleges that Life Care retaliated against employees who complained about its practices.  According to the complaint, "[a]n informal study conducted by Integrity Services found that Life Care terminated approximately 57 percent of the employees who provided their names within three weeks of filing their complaint."

Simpson Law Firm represents one of the two relators in the consolidated cases.

On November 2, 2011, the U.S. District Court for the Western District of Pennsylvania approved the government's motion to intervene in U.S. ex rel. Singh v. Bradford Regional Medical Center.  The government had previously declined to intervene, and the relators proceeded to litigate the case for more than five years without the government's involvement.  In November 2010, the district court granted the relators' motion for partial summary judment, holding that BRMC violated the federal Stark statute, prompting the government to reenter the case. 

On June 23, 2010, the United States filed its Complaint-in-Intervention against Augusta Medical Systems, LLC and Julian Osbon, after previously notifying the court that it was intervening in the action.  In its complaint, the government alleges that AMS routinely submitted claims to Medicare and other government payors for durable medical equipment using the supplier number of a defunct company.

A Florida radiation therapy center agreed to pay the United States $12 million to settle claims that, among other things, it provided radiation therapy services without proper physician supervision.  The relator received a relator's share of $2.64 million, or 22% of the total recovery.