In an unprecedented decision, US District Court Judge Harry S. Mattice ruled that the federal government can use a statistical sample of a nursing home company’s Medicare claims as evidence of overbilling charges. The decision is significant because statistical sampling could greatly increase the number of claims deemed fraudulent without individualized proof. There is scant case law concerning whether extrapolation is appropriate under the False Claims Act (FCA).
The legal decision involves a whistleblower lawsuit against Life Care Centers of America under the FCA. Federal prosecutors allege that high level Life Care Centers supervisors directed healthcare workers to max out unnecessary and harmful therapies to patients for the highest possible Medicare reimbursement.
Due to the large number of claims and massive amounts of billing, the federal government proposed sampling 400 claims from 82 Life Care Centers locations and then extrapolating from those numbers to help prove that routine overbilling occurred throughout the company. Life Care Centers for America argued that the False Claims Act requires the government to prove particular instances of false claims.
In the September 29, 2014 decision, Judge Mattice wrote that “The purpose of the FCA, as well as the development and expansion of government programs as to which it may be employed, support the use of statistical sampling in complex FCA actions where a claim-by-claim review is impracticable.” He believed that the sheer number of claims would make it impossible to consider each individually.
However, Judge Mattice will permit Life Care Centers to argue in court that not much weight should be given to the “extrapolated evidence” in order to ensure due process.
Life Care Centers of America operates more than 200 facilities, most of which are nursing homes, in 28 states, including Hickory House Nursing Home in Honey Brook, Pennsylvania. According to the Chattanooga Free Press, Medicare has reimbursed $4.2 billion to Life Care Centers between 2006 and 2011.
The consolidated cases are USA ex rel. Martin et al. v. Life Care Centers of America Inc., case number 1:08-cv-00251, and U.S. ex rel. Taylor v. Life Care Centers of America Inc., case number 1:12-cv-00064 in the U.S. District Court for the Eastern District of Tennessee.
If you are concerned that your loved one may be a victim of abuse at a care facility, call nursing home neglect attorney and whistleblower lawyer in Philadelphia, PA Brent Wieand at (888) 789-3161, or contact our law offices online to arrange for a completely free and confidential legal consultation.
