Michael Brevda: Holding nursing homes accountable

SavaSeniorCare LLC, a skilled nursing facility corporation with facilities in Pennsylvania, has agreed to pay more than $11 million (in addition to further penalties, should certain contingencies occur) to resolve allegations that the entity violated the False Claims Act by billing Medicare for services fraudulently. The complaint against Sava made claims against Sava’s behavior from 2008-12. During this time, it was alleged that Sava billed Medicare for rehabilitative services that residents did not need or that were not performed at a level of quality that made them effective.

This case was initially brought forth using the False Claims Act’s provisions for whistleblowers. As attorneys representing whistleblowers in long-term care facility settings, we commonly see allegations like these. The multi-million settlement sum, however, is significant.

One of the alleged drivers behind Sava’s actions appeared to be the company’s pressure on its nursing facilities to meet unrealistic and stringent financial benchmarks, which prompted the interest in billing for services that Medicare and Medicaid labeled as “worthless” or “substandard.” In some cases, this involved prescribing rehabilitative therapy to residents who did not need it.

For example, sometimes a facility will perform intense physical , occupational and speech therapy on a non-responsive resident. These hours of therapy will not result in any kind of progress in the patient. Instead, they are performed simply to make money and bill Medicare.

In other allegations brought by the U.S. government against Sava, it was alleged that Sava failed to discharge patients in a timely manner, even when they were medically ready and able to be discharged.

This happens in other corporate nursing home chains. If a facility is under census and not at capacity, the clinical team may hang on to a resident for additional time, simply because the resident has “good insurance.”

The government also maintained allegations that Sava’s nursing care services did not meet the federal standards for adequate levels of care, either through interaction with residents or through the failure to meet appropriate staffing levels.

When a nursing home fails to provide enough staff to care for residents, injuries are inevitable. The most common culprit of neglect-related injuries like bed sores, falls and wrongful death is understaffing.

Sava will pay the government $11.2 million. Going forward, Sava has agreed to comply with a five-year corporate integrity agreement that will annually review patient outcomes and treatment using an independent third party. Despite settling for the large monetary amount, the Sava representative called the government’s allegations “unfounded” and denied all wrongdoing.

In an underregulated nursing home industry that is heavily focused on profits, whistleblower claims like these are one of the only ways to hold nursing home corporations accountable for wrongdoing. Kudos to the relator whistleblowers who exposed this fraud, and the zealous Department of Justice legal team who prosecuted the case.

Michael Brevda is managing partner at the nationwide Senior Justice Law Firm.