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Nursing Home Chain Settles Medicare Fraud Allegations for $10M

Whistleblowers allege Saber® Healthcare Group encouraged the submission of false Medicare claims at its skilled nursing assisted living facilities.

Saber Healthcare Group LLC, and its related entities, (Saber) have agreed to pay $10 million, resolving allegations that Saber violated the False Claims Act by knowingly causing its facilities to submit false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary, or skilled.

The lawsuit was filed by former Saber rehabilitation therapists and therapy managers under the whistleblower provision of the False Claims Act. The whistleblowers are Hope Wright, Laura Webb, and Deborah Edmonds.

Wm. Paul Lawrence, II, of counsel at Waters & Kraus, said “we were proud to represent three very brave whistleblowers who refused to go along with fraud and lost their jobs as a consequence.

According to an announcement the Department of Justice issued on April 14, 2020, Medicare reimburses skilled nursing facilities at a daily rate reflecting the needs of qualifying patients. The highest level of Medicare reimbursement for skilled nursing facilities is for “Ultra High” patients, who require extensive skilled therapy from multiple therapy disciplines.

The lawsuit alleged that Saber enforced goals to increase billing by pressuring therapists to provide Ultra High therapy to each patient at nine of its facilities. The allegations further contended that Saber pressured facility directors to ensure therapists provided the Ultra High therapy to each patient, prevented therapists from providing lower levels of therapy minutes if, in the therapists’ clinical judgment, a lower amount was warranted, caused therapists to report time spent on initial evaluations as therapy time in violation of Medicare policy, and caused therapists to report time spent providing unskilled services as time spent on skilled therapy.

The case is captioned United States ex rel. Wright et al. v. Saber Healthcare Holdings, LLC et al., Case No. 2:16-cv-640 (E.D. Va.). The whistleblowers are represented by Charles S. Siegel and Wm. Paul Lawrence, II of Waters & Kraus, LLP and Jeffrey Newman of the Law Offices of Jeffrey A. Newman & Associates.

Saber has also entered into a confidential settlement with the whistleblowers resolving allegations of retaliation.

About Waters & Kraus, LLP

Waters & Kraus is a national plaintiffs’ firm with lawyers practicing qui tam whistleblower and False Claims Act litigation nationwide from primary offices in Dallas, Texas, and Los Angeles, California, with satellite offices on the east coast and elsewhere. Our attorneys represent whistleblowers exposing fraud against the government in a variety of healthcare matters, including off-label or false marketing of medical devices and drugs, retail pharmacy DUR and diagnosis restriction fraud, hospital domestic-care fraud, hospital wage index fraud, skilled nursing facility resource utilization group (RUG) and productivity quota fraud, long-term care hospital (LTCH) fraud, intensive rehab facility (IRF) fraud, hospice facility fraud, mobile imaging facility fraud, and medical provider kickback fraud. Contact us at 800.226.9880 to learn more about our practice and our qui tam attorneys.

Waters Kraus & Paul is the West Coast practice of Waters & Kraus, LLP, a national plaintiffs’ law firm.

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