After being initially cleared of charges, Brookdale Senior Living (NYSE: BKD) again finds itself engaged in a legal battle over alleged Medicare fraud for home health.
The whistleblower case was brought by a former Brookdale employee, Marjorie Prather. She accused Brookdale of improper billing for home health services that added up to approximately $35 million. Brentwood, Tennessee-based Brookdale is the nation’s largest senior living provider and also one of the 10 largest home health providers.
The case was dismissed in 2015 due to lack of sufficient evidence. However, Last week, the Sixth Circuit Court of Appeals reversed the dismissal of Prather’s claims about the submission of false or fraudulent claims for payment and the fraudulent retention of payments by Brookdale, according to court documents.
Prather was hired by Brookdale to review documentation related to clients who had received home health services; she became aware that the required certifications from a doctor stating that the patient needed home health services, established a plan of care, and met with the patients, were all signed after the care had been provided, according to court documents.
She brought the issue to her supervisors but was told to ignore the issues, and one official said “[w]e can just argue in our favor if we get audited,” Prather claimed.
There was a sense of urgency around getting the documents signed because the company was already behind on paperwork that was supposed to be submitted to Medicare, the charges state. These instances made Prather believe Brookdale had provided the home health services to patients without the aid of a doctor and then found doctors after the fact to validate the documents.
Prather used evidence from her work to bring a lawsuit under the False Claims Act. The appellate court reversed the dismissal of the circuit court from 2015 and stated that the documents weren’t signed by physicians until months after care was given, and the law states that the signatures from the doctors must be completed as soon as possible after the plan for a patient’s care is established.
The appellate court also disagreed with the circuit court’s assertion that Prather didn’t sufficiently plead the submission of the claim, so they have reversed the dismissal of her fraudulent retention of payments claim.
“We are disappointed by the ruling and agree with the dissenting opinion,” Brookdale told Home Health Care News. “Our company is committed to a high level of quality of care for our patients and over the years has operated in their best interest. We intend to vigorously defend ourselves in this case moving forward.”
Both courts do agree that Prather did not show enough evidence to support her false records claim, so that will remain dismissed.
Written by Alana Stramowski