Medicare/Medicaid Fraud Archives

Report Says Medicare Part C Insurers Are Pocketing Billions Through Risk Adjustment Schemes

Oct 04 2024

Medicare Advantage, or Part C, was created with the idea that private insurers could provide more cost-effective healthcare than traditional Medicare. But while the program has become popular — it’s the largest taxpayer-funded health insurance program in the United States with a $450 billion annual budget and more than 31 million participants — it is losing billions to fraud.

As recent False Claims Act settlements and a recent report in the Wall Street Journal show, one of the costliest schemes that threatens the financial health of Medicare Advantage is risk adjustment fraud. Simply put, Medicare Part C insurers can diagnose patients with diseases they are never treated for, then pocket the extra money the government pays insurance companies to provide treatment for certain medical conditions.

The WSJ’s analysis of billions of Medicare records found private insurers made “hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded” Medicare Part C payments from 2018-2021. The newspaper’s analysis showed that Medicare paid insurers about $50 billion for diagnoses added just by insurers in the three years ending in 2021. Reporting by the WSJ also found that:

Insurers added diabetic cataract diagnoses to 148 patients treated by one ophthalmologist in Arizona, who said he saw “at most one or two such cases” of that diagnosis per year.
“18,000 Medicare Advantage recipients had insurer-driven diagnoses of HIV, the virus that causes AIDS, but weren’t receiving treatment for the virus from doctors, between 2018 and 2021, the data showed. Each HIV diagnosis generates about $3,000 a year in added payments to insurers.”

Whereas in traditional Medicare the government is paying providers for each medically necessary need or service that’s covered by the plan, in Part C the government pays private insurance plans a fixed monthly payment per each Medicare Advantage enrollee to cover their needs.

That fixed monthly payment can be increased, however, through risk adjustment payments, which provide private insurers an additional amount above the fixed monthly payment to account for specific needs of Medicare Advantage enrollees and discourage plans only enrolling healthier people. The Centers for Medicare & Medicaid Services bases risk adjustment payments on enrollee diagnoses contained in encounters or claims that Medicare Advantage plans submit. If a beneficiary is diagnosed with cancer, for example, the plan will receive a higher payment as long as the patient has a cancer diagnosis in their medical record.

Partly because of risk adjustment fraud, Medicare Advantage has cost the government an extra $591 billion over the past 18 years, compared with what Medicare would have cost without the help of the private plans, according to a March report by the nonpartisan Medicare Payment Advisory Commission (MedPAC). According to the WSJ, that amounts to $4,300 per U.S. tax filer when adjusted for inflation.

Keller Grover attorneys have unique experience in risk adjustment fraud and a proven track record of getting the government’s attention to address it. We represented the whistleblower whose information led to a $90 million payout by Sutter Health, a precedent-setting settlement against a hospital system involving Medicare Advantage fraud allegations.

In that case, the whistleblower was a Certified Coder and risk adjustment manager who alleged Sutter artificially inflated its reimbursements for Medicare Advantage enrollees, claiming patients were treated for conditions they either did not have or were not treated for, which increased their risk scores and how much the government reimbursed Sutter for their care.

In another case last year, Cigna agreed to pay $172 million to resolve allegations that it violated the False Claims Act after it was accused of submitting inaccurate diagnoses codes based on health risk assessments and chart reviews for its Medicare Advantage enrollees.

Oftentimes, whistleblowers are the only ones who can speak up and stop risk adjustment fraud in Medicare Part C. When a FCA case is successful, the whistleblower typically receives a portion of the fraud recovered, ranging between 15% and 30%. In fiscal year 2023, the government paid $350 million to whistleblowers.

If you have information about risk adjustment fraud or other fraud in Medicare Part C, contact Keller Grover for a confidential, free consultation. We can advise potential whistleblowers about the best path forward from the very beginning, helping minimize the impact of reporting, protect rights and achieve the best possible outcome for the situation.

Government watchdog flags risk-adjusted Medicare Advantage payments

Oct 15 2021

In September, the U.S. Department of Health and Human Services’ Office of Inspector General issued a report raising concerns that some Medicare Advantage companies inappropriately used chart reviews and health risk assessments, or HRAs, to receive higher risk-adjusted payments.

The OIG found that 20 of the country’s 162 MA companies accounted for a disproportionate share of $9.2 billion in payments from diagnoses that were only reported on chart reviews and HRAs. Of the 20 companies, one company stood out for having 40 percent of the risk-adjusted payments from both chart reviews and HRAs but enrolled only 22 percent of MA beneficiaries. The report did not name the companies.

The OIG recommended that the Centers for Medicare & Medicaid Services provide oversight of the 20 companies, take additional actions to determine the appropriateness of payments and care for the one company that substantially drove risk-adjusted payments, and work to monitor and identify MA companies with a disproportionate share of risk-adjusted payments from chart reviews and HRAs.

Whistleblowers play an important role in rooting out Medicare Advantage fraud, especially when it involves manipulation of risk-adjusted scores to obtain higher reimbursements for either the Medicare Advantage company or the healthcare provider who cares for the Medicare beneficiary. The False Claims Act incentivizes whistleblowers to report fraud on the government by rewarding them with a percentage of the amount the government recovers because of the whistleblower’s case. According to the Taxpayers Against Fraud Education Fund, between 2010 and 2020, the government’s FCA recoveries totaled $40.2 billion. Of that total, about 68 percent came from healthcare-related recoveries.

In August, a Keller Grover client reached a record $90 million False Claims Act settlement with Sutter Health, a healthcare provider, to resolve her alleged claims that the health system submitted inaccurate and unsupported medical diagnosis codes, which inflated its Medicare Advantage reimbursements. We are here to help those who want to report wrongdoing. For advice about how to handle suspected fraud, contact Keller Grover for a free and confidential consultation. Over more than 30 years litigating fraud and employment cases, Keller Grover has recovered billions for its clients.

Keller Grover, Constantine Cannon and Kleiman Rajaram Announce Record $90 Million False Claims Act Whistleblower Settlement with Sutter Health

Aug 31 2021

Sutter Health settles closely watched whistleblower lawsuit alleging it violated the False Claims Act by submitting inaccurate and unsupported medical information on tens of thousands of patients enrolled in Medicare Advantage.

SAN FRANCISCO, Aug. 31, 2021 /PRNewswire/ — Keller Grover, Constantine Cannon, and Kleiman Rajaram announce the landmark $90 million False Claims Act settlement against Sutter Health on behalf of their whistleblower client, Kathy Ormsby, over allegations that Sutter committed massive Medicare Advantage fraud over the course of roughly six years.

The settlement is the largest False Claims Act (FCA) settlement against a hospital system involving allegations of fraud on the Medicare Advantage program, and the second largest reported Medicare Advantage fraud settlement ever.

The settlement resolves this case as the U.S. Department of Justice announced its intervention in a series of Medicare Advantage fraud cases in recent weeks. Medicare Advantage (also known as Medicare Part C) has seen its enrollment double over the past decade and is now a $350 billion market annually. More than 41% of all Medicare beneficiaries are now enrolled in Medicare Advantage Plans.

Ms. Ormsby filed her lawsuit in 2015 under the qui tam provisions of the False Claims Act, which permit whistleblowers to file lawsuits to recover taxpayer dollars lost to fraud committed against the government. Ms. Ormsby alleged that Sutter, through several affiliates including Palo Alto Medical Foundation (PAMF), intentionally or recklessly submitted inaccurate and unsupported medical diagnosis codes that inflated Sutter’s reimbursements from Medicare Part C, known as the Medicare Advantage Program.

Medicare Part C authorizes qualified individuals to opt out of traditional fee-for-service coverage under Medicare Parts A and B and enroll in privately-run managed care plans that provide coverage for both inpatient and outpatient services. Unlike the traditional fee-for-service model, Medicare Part C pays for care with monthly amounts based on the health of the patient as documented in diagnosis codes in their medical records, known as a risk adjustment factor (RAF). Ms. Ormsby was employed at Sutter as a RAF Manager.

After investigating Ms. Ormsby’s allegations, including extensive cooperation from Ms. Ormsby and her attorneys, the Department of Justice intervened in the portion of Ms. Ormsby’s case relating to PAMF. As expressly contemplated by the False Claims Act, Ms. Ormsby continued to pursue the non-intervened claims related to the alleged fraud at Sutter’s other affiliates. The settlement followed Sutter’s unsuccessful effort to dismiss both the government’s complaint and Ms. Ormsby’s. The order denying Sutter’s motions to dismiss created important precedent for future False Claims Act cases alleging Medicare Advantage fraud.

Kathleen R. Scanlan of Keller Grover LLP, counsel for Ms. Ormsby, said: “Today’s settlement is a terrific victory for taxpayers. Kathy Ormsby was the catalyst behind the return of nearly a hundred million dollars to a program we all fund to provide cost-effective healthcare to the most vulnerable in our communities, the elderly. Her case also sends a powerful message to other healthcare providers in the Part C program: gaming a patient’s RAF score is fraud, and you can be held responsible for it under the False Claims Act.”

Jeffrey F. Keller of Keller Grover LLP, added: “Kathy Ormsby demonstrated tremendous courage when she came forward to allege a major fraud on the Medicare Part C program by California’s second largest healthcare provider. Representing her in this case has been an absolute privilege. Hopefully she inspires others to follow her lead in reporting allegations of fraud on the government.”

Gordon Schnell of Constantine Cannon, said: “We are all grateful for the heroic efforts of our frontline healthcare workers, especially over the last 18 months fighting COVID-19. This case highlights the other heroic individuals in our healthcare system, people like Kathy Ormsby who risk their career and personal well-being to make sure our healthcare system places patients before profits.”

Mark Kleiman of Kleiman Rajaram said: “This case is an important example of whistleblowers and their lawyers partnering with the government to bring extra expertise and legal firepower to the fight against fraud. This is just how the False Claims Act was intended to work. We hope it serves as a model for more cooperation between the government and whistleblowers in the future.”

Under the False Claims Act’s whistleblower reward provision, Ms. Ormsby is entitled to 15-30% of the settlement amount for her vital role in bringing this matter forward and helping secure this record settlement for the government.

In addition to Ms. Scanlan, Mr. Keller, Mr. Schnell, and Mr. Kleiman, Ms. Ormsby was also represented by Sarah P. Alexander, Hamsa Mahendranathan, and Gary Reilly of Constantine Cannon and Pooja Rajaram of Kleiman Rajaram.

Ms. Ormsby and her entire legal team acknowledge the hard work of the Justice Department’s legal team, including Olga Yevtekhova and Jenny Koh at Civil Frauds, and Chief of the U.S. Attorney’s Office for the Northern District of California’s Civil Division, Sara Winslow, Assistant U.S. Attorney Ben Wolinsky and former Assistant U.S. Attorneys Kim Friday and Erica Hitchings at the U.S Attorney’s Office for the Northern District of California.

For more information about the proceedings in this case, including the complaints and the court’s order on the motion to dismiss, please visit www.medicareadvantagefraud.com

About Ms. Ormsby’s Legal Team
Ms. Ormsby legal team is made up of dedicated whistleblower lawyers who represent whistleblowers under federal and state False Claims Acts as well as the whistleblower programs of the IRS, SEC, CFTC, DOT, and others.

Keller Grover is a San Francisco-based boutique law firm dedicated to representing whistleblowers, employees and victims of fraud. With over 30 years of litigation experience and billions in settlements, the firm’s lawyers are recognized as leaders in their field.

Constantine Cannon has the world’s largest international whistleblower practice, with offices in New York, Washington, D.C., San Francisco, and London. The firm is also home to an antitrust practice that is among the largest and most well recognized in the United States. Other practice areas include commercial litigation, securities, government relations and e-discovery.

Kleiman Rajaram has a national practice representing health care whistleblowers since 1996 and has represented whistleblowers in health and government contracting cases leading to over $650 million in recoveries for fraud against government programs.

Five Ways Hospice Providers Use Terminally Ill Patients to Rip Off Taxpayers

Feb 03 2017

Hospice care is the provision of specialized palliative treatment for terminally ill patients, focused not on curing them but making their last days as comfortable as possible. Hospice has gone from a grassroots movement on the outskirts of the U.S. medical establishment to a massive, multibillion-dollar industry. And as it has come of age, it has increasingly attracted the same type of fraud, waste, and abuse that plagues U.S. healthcare at large.

Hospice treatment has been covered by Medicare has since 1982, and its utilization has grown by leaps and bounds in recent years as for-profit providers have poured into the market: Almost half of all Medicare recipients who died in 2013 utilized hospice care. That year, 85 percent of the 1.5 million to 1.6 million patients who received hospice care had their treatment paid for by Medicare—to the tune of $15.1 billion.

Hospice can offer an appealing business opportunity because making a patient’s final days more comfortable is less complex than trying to cure a disease. Moreover, palliative care can be delivered anywhere—in hospitals, specialized hospice facilities, nursing homes, or even the patient’s own home. But it is also labor-intensive, meaning there isn’t much room to increase profits by improving efficiency. Moreover, Medicare’s reimbursement rates are calculated to guarantee hospice providers around a 6 percent return—not much of a profit. So making money becomes a volume game in which for-profit hospices push to serve more patients, deliver more treatments, or both.

Not surprisingly, then, much hospice fraud revolves around illegal schemes to obtain new patients or piling on medically unnecessary services. If hospice care follows the same pattern as Medicare as a whole, taxpayers may be losing upward of $1.4 billion annually to fraud, waste, abuse, and other “improper payments.”

The federal government is fighting back, and in 2015 it prosecuted more than 60 cases of hospice fraud worth hundreds of millions of dollars. The government relies heavily on whistleblower suits under the False Claims Act to be its eyes and ears in detecting these healthcare scams. Whistleblowers can be anyone who observe fraud, waste, or abuse against the government (like Medicare and other programs), and are often employees who witness or come to possess evidence of such conduct in their workplaces. Under the False Claims Act’s qui tam provisions, whistleblowers (called “relators” in False Claims Act parlance) can file suit on behalf of the United States and may be entitled to a share of money recovered.

Here are five ways unscrupulous hospice providers use and abuse Medicare, taxpayers, and the terminally ill. If you think you’ve encountered any of these, it may be worth consulting an attorney to see if you have a whistleblower case.

1. Can patients stay in hospice care even their prognosis changes to non-terminal?

There’s a reason that on average, for-profit hospices serve patients for nearly twice as many days as nonprofit hospices: Longer stays generally equal more money. It should be no surprise that the proportion of patients who were discharged alive from hospice care increased by around 50 percent between 2002 and 2012.

Sometimes patients enter hospice care with a terminal prognosis but their health subsequently improves. Instead of releasing such patients, the hospice falsely certifies that they’re still terminal and keeps them around. Medicare continues to pay its hospice per diem rate, while the costs associated with the patients drops off significantly because they no longer need palliative care.

But why wait for a patient’s prognosis to improve when you can just fill beds with healthy patients? The annals of whistleblower suits are replete with stories of just such scams. Owners of for-profit hospices put tremendous pressure on employees to “recruit” patients by any means necessary. The result is “dog-eat-dog, dirty, competitive fighting” for patients and the enrollment of people who may not have terminal illnesses—and who may not even be sick. One hospice marketer was allegedly caught on tape describing how salespeople would cruise neighborhoods to find patients. “How do you solicit patients? You see somebody sitting on the front porch in a wheelchair and you hit the brakes.”Medicare requires two doctors to determine a patient has less than six months to live before it will pay for hospice care. Clearly, any good scam requires doctors willing to lie or look the other way (or at least sign whatever is put in front of them).

2. Can hospice providers lawfully pay kickbacks for patient referrals?

“Kickbacks,” or payments in exchange for patient referrals, are illegal under Medicare rules. Still, providers may try to cover their tracks by disguising the kickbacks as payments for medical services or advising. Alternatively, providers may make kickback arrangements with nursing homes and other facilities. In any event, these types of payments are a form of healthcare fraud.

3. Classifying patients as needing higher levels of care than they actually do.

Even outside the hospice context, intentionally misclassifying patients is a common Medicare scam. A skilled nursing facilities will fraudulently put patients in the most intensive category so it can bill Medicare for their treatment at the “ultra-high” reimbursement rate; the parallel in the hospice world is “continuous” or “crisis” care, often reserved for patients in the last seven days of their lives.

The patients may simply need less care than would justify placing them in the crisis category. Or they may not need any care at all. In one case, the country’s biggest hospice company at the time was accused of billing Medicare for crisis care delivered during nurse visits to the homes of patients who were actually out “at church, at the beauty parlor, or playing bingo” when nurses arrived at their homes.

4. Providing more treatment than medically necessary.

Now we’re in territory where patients are actually being abused: providing medically unnecessary treatment. Overmedication is a common form of overtreatment in hospice fraud. It’s often done with painkillers, as palliative care is largely about pain management, and who’s going to notice if a terminally ill person in a lot of pain gets a few extra injections of morphine? How about one who isn’t in that much pain?

Intentionally giving someone unnecessary medicine or treatment is a crime, grounds for a tort lawsuit, and a major violation of medical ethics rules. And taxpayers foot the bill for all the unnecessary medication.

5. Pushing patients out of hospice in order to avoid aggregate caps — including allegedly “euthanizing patients for profits.”

Medicare limits the amount it pays hospices by imposing an “aggregate cap” on how much it will pay a hospice; determining the exact figure involves multiplying an “aggregate cap value” by the number of Medicare patients the hospice treats per fiscal year. (In 2016 the aggregate cap value was $27,820.75.) If a hospice exceeds its aggregate cap, it must refund the overage to Medicare. If this happens, the provider gets hit with a huge bill and once-profitable patients suddenly become liabilities, as every extra dollar of treatment is a dollar for which it will no longer be able to bill Medicare.

One hospice owner who was already running several scams expelled hundreds of patients when it learned it had exceeded its cap and it would have to repay millions of dollars. Horrifically, another owner who hit the cap allegedly “got rid of” at least four patients by ordering nurses to euthanize them with painkiller overdoses. He allegedly sent the “execution orders” by text message, and in one message told a nurse that “[y]ou need to make this patient go bye-bye.”

One patient died after being given at least 10 doses of morphine in a seven-hour window, “even though there was no documentation of pain or respiratory distress.”

There had apparently been “whispers” of this wrongdoing before the FBI got involved—exactly the kind of information that may well have been exposed by a whistleblower.

If you feel that you or someone you know may be a victim of hospice fraud, please contact our attorneys for a free and confidential consultation.

Whistleblowers Stop Nursing Home Fraud and Patient Harm – With help from the False Claims Act

Dec 12 2016

Healthcare fraud puts patients’ lives at risk and costs billions of dollars every year. Nursing homes, which house vulnerable patients away from loved ones and the outside world, are especially fertile breeding grounds for healthcare fraud schemes. While government agencies have stepped up their enforcement efforts, nursing home workers who witness fraud are in the best position to put it to a stop—and thanks to federal and state whistleblower laws like the False Claims Act, a single principled healthcare worker can take down even the most egregious and wide-ranging frauds.

What is Healthcare Fraud?

While there’s no strict definition of “healthcare fraud,” it can be generally said to take place when someone lies in order to get paid by an insurer for medical services or goods. It can also involve knowingly engaging in prohibited conduct while participating in a government healthcare program; the most common prohibited conduct is paying for patient referrals.

In the nursing home context the insurers being defrauded are most likely to be Medicare or Medicaid, which are together responsible for more than half the payments to skilled nursing facilities (SNFs) in the US. And the “lie” can be a false statement made at any stage in the process of prescribing, providing, documenting, or billing for healthcare services. In a nursing home, all of the following would likely constitute healthcare fraud:

A doctor diagnoses patients as sicker than they actually are, or performs medically unnecessary procedures, in order to generate a bigger Medicare payout.
A rehabilitative therapy manager schedules patients for longer or more frequent therapy sessions than necessary—or with therapy that’s medically unnecessary, or even that the patient has refused—in order to maximize Medicare reimbursement rates that are based on the number of minutes of therapy provided per week.
A billing manager overstates how sick a patient is by “upcoding,” or submitting reimbursement requests to Medicare with incorrect or unwarranted reimbursement codes for more expensive services.
A facility refers patients to specific providers in exchange for kickbacks, bribes, or rebates in exchange for the referrals, or otherwise engages in prohibited conduct while participating in Medicare or Medicaid.
The executives or upper management of a large healthcare corporation encourage the above practices—or willfully turn a blind eye when subordinates engage in them—in order to increase Medicare reimbursements.

The Financial and Human Costs of Healthcare Fraud

Just how much money does healthcare fraud cost Americans? While it’s impossible to say with precision, the FBI conservatively puts the figure at $80 billion per year—likely a substantial understatement given how much fraud is not detected or reported. Yet another estimate puts the annual loss to Medicare alone at $60 billion.

An oft-cited (and possibly more accurate) estimate puts healthcare fraud losses at between 3 and 10 percent of the roughly $3 trillion spent on healthcare each year in the US, or $90 billion to $300 billion per year. Nursing and assisted living facility spending recently topped $150 billion a year, so by extension fraud in this context could be between $4.5 billion and $15 billion a year.

The cost of this massive greed is even more staggering when you factor in the human toll. A few more egregious examples include:

After surgery, an otherwise healthy grandfather enters a nursing home. Three weeks later, he is dead. Nursing home staff were too busy “providing rehabilitative therapy” to notice he had become severely dehydrated and emaciated.
Over the course of a decade, a group of cardiologists and a hospital administrator induce 750 people—including many who are homeless or addicted to drugs—to undergo unnecessary heart catheterizations, angioplasties, and other unnecessary procedures and tests in exchange for cigarettes, food, and cash. At least two of these people—“who had needles stuck in their hearts purely for profit”—died.
Doctors declaring thousands of people “terminally ill” in order to fill beds in hospice facilities, where their medical treatment ends and they receive only palliative care. It’s unknown how many people have died in hospices who might have otherwise lived.

Enforcement Agencies Struggling to Keep Up

As we’ve previously noted, federal agencies have made catching and punishing healthcare fraudsters a top priority. In a massive nationwide sweep this past June, the Medicare Fraud Strike Force charged 301 people—including 61 doctors, nurses, and other licensed healthcare professionals—were charged in relation to a whopping $900 million in false Medicare billings. It’s the biggest sweep in the nine-year history of the Strike Force, a cooperative effort of the U.S. Justice and Health and Human Services departments.

Still, even $900 million is just a drop in the bucket compared to the billions lost annually to healthcare fraud, and federal agencies’ resources are limited. That’s where everyday healthcare workers in all parts of the industry can step in.

Enter Whistleblowers

Principled healthcare employees who can no longer stay silent about Medicare or Medicaid fraud they’ve witnessed can come forward with the help of whistleblower laws like the False Claims Act. Under the False Claims Act’s qui tam provisions, a healthcare worker with evidence that a private company has knowingly submitted a false claim to the federal government can sue the company on behalf of the government and is entitled to a share of the recovery, including treble damages and penalties, even if a case settles. The False Claims Act also provides protections and remedies for whistleblowers who are fired, suspended, demoted, harrassed or discriminated in their terms and conditions of employment in retaliation for coming forward.

Since 2009, the Department of Justice has recovered over $30.6 billion through the False Claims Act. Over 60 percent of that has been in cases of federal healthcare fraud—a staggering $18.5 billion. That recovery is made possible in large part by courageous whistleblowers who decide to take a stand against the fraud they witness in their workplaces.

Thanks to the False Claims Act, even the highest corporate executives at the biggest companies in the business can be held accountable. Just this month, a whistleblower’s tip led to a $30 million settlement with North American Health Care, Inc., its board chairman, and its senior vice president of reimbursement analysis. North American operates 35 skilled nursing facilities, most in California, which provide inpatient physical, occupational, and speech therapy. The whistleblower and the Department of Justice alleged that North American billed Medicare and TRICARE (the civilian care component of the Military Health System) for medically unnecessary therapy, and that the officers contributed to the fraud by creating an improper billing scheme and reinforcing it at North American facilities.

And this past January, RehabCare—the nation’s largest nursing home therapy provider with contracts at over 1,000 SNFs in 44 states—and its parent company, Kindred Healthcare, agreed to pay a whopping $125 million to settle a False Claims Act lawsuit brought by two brave whistleblowers. Physical therapist Janet Mahoney and occupational therapist Shawn Fahey had both worked at RehabCare facilities in Massachusetts. They, along with the DOJ, alleged that RehabCare classified patients in the “ultra-high” reimbursement level—the highest possible Medicare billing category, for patients who need 720 or more minutes of therapy per week—without regard to their actual needs.

In order to get to the “magic number” of 720 minutes per week, RehabCare poured subjected patients to many more hours of therapy than they needed and even types of therapy that were not clinically indicated. RehabCare even allegedly billed for therapy provided to patients who were in fact asleep. And perhaps most sinister, some patients were allegedly kept in the facilities—even after their own therapists recommended they be discharge—so RehabCare could milk them for additional therapy minutes.

Worth the Wait

Mahoney and Fahey’s case went on for just over four years; it undoubtedly put them under significant stress. But if online comments are any indication, their blowing the whistle on RehabCare’s abusive practices has made them heroes among their peers—and hopefully emboldened others to come forward. A January 13 story about the RehabCare settlement on the American Physical Therapy Association’s PTinMotion News blog received dozens of comments, apparently from other therapists, supporting Mahoney and Fahey and recounting their own similar horror stories. Some excerpts:

“I was a contractor for three years and I cannot tell you the amount of fraud that I saw at so many facilities.”

“I was forced to leave employment in SNFs due to the pressure exerted on me to participate in these types of practices.”

And perhaps the most gratifying:

“Bravo to all for speaking up and demonstrating support for doing so! It makes me proud to be a part of our profession!”

If you or anyone you know has potential information about nursing home fraud, please contact our attorneys for a free and confidential consultation.