Government

A settlement has been reached in a whistleblower class action lawsuit brought against Regency Nursing and Rehabilitation Centers Inc who is accused of submitting false claims to Medicare and the Texas Medicaid program.

Specifically the United States complaint alleged that Regency submitted claims for reimbursement to Medicare and Medicaid for rehabilitation and skilled nursing services that were not reimbursable because the nursing home residents were not qualified for the services, the services were not medically necessary, or they were not supported by adequate documentation.

A settlement has been reached in a whistleblower class action lawsuit brought against San Mateo Medical Center (SMMC) who is accused of submitting false claims to the United States in connection with payments from the Medicare and Medicaid programs.

The whistleblower that filed the orignal complaint will receive $1,020,000.

The government alleges that SMMC falsely inflated its bed count to Medicare in order to receive higher payments under Medicare’s Disproportionate Share Hospital (DSH) adjustment. The DSH adjustment is an extra Medicare payment available to hospitals that meet certain requirements, including having 100 or more acute care beds.

In addition, the government alleges that San Mateo County improperly obtained federal payments under the Medicaid program for services provided to patients at Institutes of Mental Disease (IMDs) who were between the ages of 22 and 64. Such services are ineligible for federal funding, and San Mateo County was required to separately report them to the California Department of Mental Health so that the state could ensure that no federal funds were used to pay for them. Medicaid (known as Medi-Cal in California) is a program funded jointly by federal and state funds. The settlement covers conduct from 1997 to 2007.

A settlement has been reached in a whistleblower class action lawsuit brought against Alaska DigiTel LLC, a former Alaska limited liability company now owned by General Communication Inc. (GCI), who is accused of submitting false claims to the Federal Communications Commission’s (FCC) Low Income Support Program.

The whistleblower will receive $260,274 from the settlement.

Originally filed in 2008, the United States alleged that Alaska DigiTel violated the False Claims Act by submitting claims to the Low Income Support Program for improperly substantiated, duplicative, or otherwise ineligible subscribers for the period from Jan. 1, 2004, though Aug. 31, 2008.

The Low Income Support Program of the Universal Service Fund, which includes the Lifeline, LinkUp and Toll Limitation Services, was created by Congress in the Telecommunications Act of 1996 and is administered by the Universal Service Administrative Company for the FCC. Under the Low Income Support Program, eligible individuals may apply for free ordiscounted phone or wireless services. Reimbursement is paid directly to Eligible Telecommunications Carriers, such as Alaska DigiTel.

The whistleblowers will receive a $80,000 share of the government's recovery.

This lawsuit was originally filed in May 2008 and stemmed from a 2005 filing of a lawsuit against Kyphon Inc.  The United States' complaint alleged that Rex Healthcare routinely submitted claims to Medicare for a variety of minimally-invasive procedures during the period 2004 through 2007, which the hospital classified as inpatient admissions in order to increase its reimbursement from Medicare, despite the absence of medical necessity justifying the more expensive inpatient admissions. The government also made claims related to a variety of other minimally-invasive procedures that the hospital classified as inpatient admissions in order to increase its reimbursement when less costly outpatient visits would have been appropriate.