Signature Healthcare is a national for-profit nursing home chain with more than two dozen facilities in Tennessee.  The government started an investigation in 2014 when two whistleblowers started collecting evidence on their own.  LeeAnn Holt and Kristi Emerson, both of whom are occupational therapists from Columbia, collected reams of anecdotes — in part, because they were concerned they might get in trouble themselves.  That evidence is the basis of the $30 million settlement in the Medicare fraud case between the federal government and Louisville-based Signature Healthcare, which operates more than 100 facilities in 17 states.

According to court documents, state and federal investigators discovered Signature was “knowingly submitting false claims to Medicare for rehabilitation therapy services that were not reasonable or necessary” at 115 of its facilities. Investigators said that led to a total of $232 million in false claims. The company also allegedly forged documents submitted to Tennessee’s Medicaid or Tenncare program, leading to another $12 million in fraudulent reimbursements.  So they stole $232 million but only had to pay a settlement of $30 million.  Who says crime doesn’t pay?

The complaint against Signature Healthcare (download here) accuses the company of systematically administering occupational, physical and speech therapy when it wasn’t warranted and withholding care when government reimbursements were already maxed out. According to the suit, the unnecessary therapy pushed patients into a category where the facility was reimbursed more per day for those patients, often hitting precisely the 720-minute per week threshold for maximum payment.  Holt and Kristi Emerson are the whistle-blowers who exposed a company-wide system of over-billing the federal government by Signature Healthcare.

“There were a couple of times when things happened with patients where we would just look at each other and say, ‘We can’t do this. We just cannot do this any more,'” LeeAnn Holt recalled.  Holt recalls a patient with advanced cancer who just wanted to spend time with her family rather than continue with therapy.

“She just put her hand on the therapist and said, ‘Honey, you need to go work with somebody that can really benefit from this.’ And you know, when you have a patient that is telling you that, you really have to stop and take inventory of what is going on here.”

Emerson says she hopes the case will still inspire other health care workers to push back when they feel pressured to do procedures they deem medically unnecessary.

“We can’t just blame these corporations for all of this,” she says. “We have to shoulder as therapists some of the responsibility because we’ve allowed this to get this bad.”

The women say before filing their suit, they repeatedly went to administrators all the way up to the corporate office.

“And no one was doing anything. And the more we reported, the more they came in and just started pushing back on us,” Emerson explained.

Emerson and Holt were let go amid the investigation and have found it difficult to find stable work. “No one really wants a whistleblower in their building,” Emerson says.

But now they will split roughly $6 million as their share of the settlement. Whistleblowers are entitled to 15 percent to 25 percent of the total.

 

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