(eh) Download PDF Search this Case Google Scholar Google Books Legal Blogs Google Web Division Vice Presidents ("DVPs") of Rehabilitation Services report directly to Ms. Hallissey; the Regional Director of Rehabilitation ("RDR") in each region reported to his or her DVP. Asercare, 153 F. Supp.3d at 1381). Sheldon, 816 F.3d at 411. Indeed, United States v. Asercare, Inc., 153 F. Supp.3d 1372 (N.D. Ala. 2015), on which SAS relies for the proposition that a "difference of opinion" on the question of medical necessity is not enough, was decided in the context of a motion for a new trial. Manage Settings NA - Not available or not applicable United Distributors Inc., W.B. Bloomberg Daybreak Middle East. Further, the caption alone runs more than 9 pages, and 184 paragraphs and 32pages are spent just on identifying the parties. In Life Care, the Government sued Life Care which, like present Defendants, operated a chain of SNF, and which, like here, allegedly provided unreasonable and unnecessary rehabilitation therapy services to increase its profits by billing more patients to Medicare at the Ultra High RUG level. into improving their performance." 118 & 125). SavaSeniorCare provides health care, rehabilitation, physical therapy, and daily living assistance, as well as help with dementia and intravenous therapy. 106 (E.D. There is often a lag time between the reporting of a change and its appearance in our database. Defendants correctly observe that "[g]ranting a motion to dismiss after the Government files a complaint in intervention is unusual." At least two therapy disciplines3. Similarly, the regulation on which SAS relies provides that "[e]ach resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychological well-being, in accordance with the comprehensive assessment and plan of care." Defendants continue: "Taking as true Kuyoki's allegations, these allegations are entirely consistent with legal conduct." SAVASENIORCARE LLC is associated with 2 skilled nursing homes that CMS have been associated with possible abuse. There may be an even more fundamental problem with SAS's argument. However, those Relators' Motions to Sever and Stay their retaliation claims will be granted. United States ex rel. at 3). (DOCKET TEXT SUMMARY ONLY-ATTORNEYS MUST OPEN THE PDF AND READ THE ORDER.) bargain' between the Government and a SNF." 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Presumably, even under the objectively false standard a claim can be false, notwithstanding a clinician's prescription. 1395y(a)(1)(A) (proscribing payment under Medicare Part A or Part B unless items or services are "reasonable and necessary"); 42 C.F.R. (CC 54). Defendants removed the action to this Court. v. SavaSeniorCare, Inc., et al., Civil Action No. Minimum 500 minutes per week total therapy2. Radio, LLC : Delaware: AA Music Management, LLC Therapy must be provided at least 5 days/week3. SavaSeniorCare LLC failed to dodge a massive False Claims Act suit initially brought by a whistleblower against the rehabilitation therapy company, when a Tennessee federal judge refused Tuesday . Sava knew the financial benefits of increasing its Ultra High billings. Defendants' professed concern about imposing "crippling FCA liability for services consistent with Medicare's HPL mandate . Even though the Court in many instances draws heavily on the exact language in the Consolidated Complaint, it serves no useful purpose to provide repeated citations to that document. 3730(c)(1). Two standards of review govern this Court's consideration of the alleged false statements and Defendants' Motion to Dismiss the same. Minimum 325 minutes per week total therapy2. Also Known As SavaSeniorCare Legal Name Savaseniorcare Administrative Services, LLC. Cataldo v. United States Steel Corp., 676 F.3d 542, 551-52 (6th Cir. Disciplines include physical therapy, occupational therapy, and speech-language pathology. See, United States ex rel. Characterizing the requirement that a patient receive such care as the "HPL Mandate," SAS insists that the Government's failure to acknowledge - let alone consider - this requirement is fatal to the Consolidated Complaint. 2011). Sava Senior Care, located in San Antonio, TX, is a residential facility for older adults who require daily care assistance. Defendants next argue that Relator "does not identify any individual patients, much less any medically unnecessary services" and that the "closest Kukoyi ever comes to pleading an actual patient example is in Paragraph 325 of her FAC, where she alleges that she 'knows of two elderly male patients who were continually billed under Medicare Part A but did not receive the services for which Medicare was billed.'" Instead, the Court provides specific citations only for the material appearing in quotation marks. Atlanta-based SavaSeniorCare announced Tuesday its intentions to create a more "nimble, regional organization" by transferring operations of 48 skilled nursing and assisted living facilities in eight states. Ky. Mar. 2d 1008, 1017 (D. Ariz. 2011) (finding FCA claim insufficiently pled where plaintiff did "not plead facts showing why the procedures performed on Patient B were unnecessary"); United States v. Caris Life Scis., Inc., 2013 WL 11579021, at *3 (N.D. Tex. The entity's status is Active now. (Id. One facility even used a form explicitly requiring therapists not to write discharge orders without first obtaining approval from an RPM and/or RDR, and explicit length of stay goals were imposed by Sava on some facilities. GRANTING SAVASENIORCARE, LLC AND CAMBRIDGE SOUTH, INC.'S MOTION TO DISMISS. Particularity of Specific False Claims. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Thornton, et al. The corporate rehabilitation department is led by Stacey Hallissey, who served from 2006 through at least 2012 as SVP of Rehabilitation Services and reported directly to Mr. Oglesby. 3:11-00821), Terrence Scott (Case No. However, the Court does not read any of those cases as suggesting that anything beyond "reasonable and necessary" must be pled in a FCA case alleging improper submissions to Medicare. The daily reimbursement rate from Medicare for skilled nursing services and rehabilitation care varies based on the anticipated nursing and rehabilitation needs of the beneficiary. Defendants seek dismissal of the state law claims for the same reasons advance with respect to the FCA claims because the same heightened pleading standards apply to both sets of claims. 2003) (finding FCA claim sufficiently plead even though plaintiff could not provide patient names or exact dates on which allegedly false claims were submitted); United States ex rel. Common to the Motions to Dismiss is that the allegations fail to state a claim and, more specifically, that the alleged false statements are insufficiently plead. Table below shows each skilled nursing home that SAVASENIORCARE LLC is associated with, the nursing home's overall 5-star quality rating and provides a link to a comparison on the home to its local competition. The transfers are expected to be completed by the end of 2021, according to the firm. SavaSeniorCare Administrative Services LLC 20,509 followers 8mo On #internationalwomensday, we celebrate the unwavering spirit and tireless dedication of women everywhere, especially the women. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Sansbury v. LB & B Assoc. Such practices ignored patient needs, sometimes resulting in patients unnecessarily exhausting all 100 days of the Medicare SNF benefit. . 2023 SavaSeniorCare Administrative Services LLC | All Rights Reserved. The essence of the Government's Complaint is that, between October 1, 2008, and September 30, 2012, Defendants SavaSeniorCare, LLC, SavaSeniorCare Consulting, LLC, SavaSeniorCare Administrative Services, LLC, and SSC Submaster Holdings, LLC (collectively "Sava" or "Defendants,") improperly received millions of dollars by submitting false or fraudulent claims for payment to Medicare for rehabilitation services that were not medically reasonable and necessary and/or not skilled in nature. And, on the Medicare claims that are not intervened, Defendants argue for dismissal using very broad strokes. Musks TeslaMaster Plan Lacks Drive. This documentary-style series follows investigative journalists as they uncover the truth. Even though DVPs of Rehabilitation Services and RDRs could change the budget for a facility in their division or region, any changes had to be "budget neutral," meaning that if an RU goal was reduced at one facility, it had to be increased at another. Relator Scott voluntarily dismissed Counts III and V of his First Amended Complaint and all other non-intervened allegations (Docket No. Finding the complaint sufficient, the United States District Court for the Eastern District of Tennessee wrote: SAS's efforts to distinguish Life Care are unavailing. rel. (Docket No. (CC 81, 82). . . As in United States ex rel. The Medicare program is divided into four "Parts" that cover different services. It argues: In addition to the reasons advanced by SAS, Defendant SeniorCare moves to dismiss on the grounds that it is barely mentioned in the Consolidated Complaint and "[f]ew averments directly referenc[e] any actions allegedly taken by, or attributable to" SeniorCare. It argues in relation to Patient B: On its face, SAS's argument contains a fatal factual assumption - Patient B's highest practicable level was to climb 16 steps, and, therefore, there could be no fraud. Yuhasz v. Brush Wellman, Inc., 341 F.3d 559, 563 (6th Cir. In fact, according to SAS, the CMS has promulgated "a regulation stating that, with respect to treatment provided by SNFs, '[c]linical disagreement does not constitute a material and false statement.'" (Docket No. Completion of the MDS is a prerequisite to payment under Medicare. must be reasonable and necessary to qualify for Medicare coverage."). Up until October 1, 2010, an hour of group or concurrent therapy could be attributed as 60 minutes for each participant when determining the RUG level. July 18, 2016) ("as for the sufficiency of [relator's] allegations on the intervened claims, Defendants' arguments are moot because the United States' allegations, not [relator's] allegations, control as to the intervened claims"). NursingHomeDatabase offers data exports as Excel spreadsheets or APIs for companies or individuals that need ownership information for more than one facility. (CC 71). The Court is unpersuaded by any of these arguments. 31 U.S.C. SavaSeniorCare Administrative Services LLC is in the sectors of: Healthcare Provision. Second, "[i]n this Circuit, there is '[a] clear and unequivocal requirement that a relator allege specific false claims' when pleading a violation of the FCA," United States ex rel. Fill out this form, and we'll contact you soon. . See United States ex rel. 9, 2013) (citing Bledsoe, 501 F.3d at 509). Hill v. Morehouse Med. Thus, each of the SNFs was given set goals that were based on meeting pre-determined RU levels and Medicare Part A daily rates. 147 at 6). Strategies were employed to retain patients, such as requiring facilities to seek permission from RDRs before discharging Medicare beneficiaries who had yet to exhaust their 100-day SNF benefit, even though those RDRs had likely never met, evaluated, or had any firsthand knowledge regarding the clinical needs of any of the patients. For older adults who require daily care assistance Delaware: AA Music Management LLC... 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