Major healthcare fraud has been alleged against a healthcare company based in Kentucky, for allegedly submitting false claims to Medicare for rehabilitation therapy services.

Signature HealthCARE LLC has recently agreed to pay over $30 million to settle the healthcare fraud allegations, which stated that the false Medicare bills called for unreasonable compensation and that the therapy services were often not needed.

According to the qui tam lawsuit, Signature allegedly did this to increase their own profit margins and had preyed upon one of the most vulnerable patient populations in the United States.

This qui tam lawsuit was filed by whistleblowers Kristi E. and LeeAnn T., who were former Signature therapy employees, alleging the healthcare company had submitted false claims to Medicare and Tennessee’s Medicaid program.

Signature had reportedly provided physical therapy services to patients whether it was needed or not. The healthcare company had based this decision on “corporate financial considerations rather than a patient’s medical needs” as stated by Special Agent Derrick L. Jackson for the U.S. Department of Health and Human Services, Office of Inspector General, in a press release.

Overview of Healthcare Fraud Allegations

The qui tam lawsuit alleges Signature had committed healthcare fraud by submitting Medicare claims for unnecessary services that were sometimes performed by unqualified professionals. The alleged healthcare fraud misconduct included:

• Placing patients at the highest reimbursement level without properly evaluating each individual case, which means that such services were not necessary for every patient’s clinical needs.
• Performing the minimum required minutes for the bill designated by the reimbursement level, while recommending against additional therapy.
• Pressuring therapists and patients to complete the designated minutes for each therapy patient, even if the patient was sick or did not want to do any of the exercises.

Healthcare fraud is one of the most significant forms of financial fraud the federal government faces. It commonly involves sending false bills to Medicare, Medicaid, and other federal healthcare programs.

Similar to the allegations in the qui tam lawsuit mentioned above, sending false bills often involves upcoding for higher compensation for services that were either not provided or performed by unqualified professionals.

Healthcare fraud is often committed by healthcare facilities like hospitals or home healthcare agencies, but can also be committed by physicians, pharmacies, medical service providers, and even ambulance transport companies. Considering that healthcare fraud often affects the elderly, the federal government takes any reported incidents very seriously.

“Our most vulnerable citizens are put at risk when healthcare providers put their financial interests above their patients’ needs and valuable federal funds are diverted from where they are surely needed. [T]his settlement demonstrates our commitment to pursuing healthcare providers who provide unnecessary care to advance their bottom line,” said an attorney involved in the qui tam lawsuit.

According to the healthcare fraud settlement, the allegations of fraud against the federal government and Tennessee’s Medicaid program will be resolved. Tennessee’s Medicaid program will receive a portion of the $30 million settlement, with Signature allegedly also submitting false claims to them. As whistleblowers in the claim, Kristi and LeeAnn may receive up to 30 percent of the settlement.

This Healthcare Fraud Lawsuit is Case No. 1:15-cv-00027 in the U.S. District Court for the Middle District of Tennessee.