Here is full text of the 360 article I posted earlier today. Subscription needed, I managed to find it. Select Medical Corp harmed my Mom: _____________________ Select Medical Hit With FCA Suit Over Length Of Patient Stays By David Siegel Law360, New York (July 23, 2014, 5:30 PM ET) -- A Wisconsin federal judge on Tuesday unsealed a whistleblower suit brought under the False Claims Act alleging Select Medical Holdings Corp. performed medically unnecessary treatments at a long-term acute care hospital to fraudulently maximize reimbursements from the Centers for Medicare and Medicaid Services. In a qui tam action initially filed under seal on July 17, plaintiff Todd Schmadl, a registered nurse who worked at Select Specialty Hospital-Madison Inc. from June 2011 to February 2012, alleges the hospital routinely discharged patients later than was medically necessary to increase reimbursement rates. “As a regular practice at Select-Madison, patients’ treatment and discharge decisions were not based solely on patient needs but on decisions to increase the profitability of Select-Madison,” the complaint states. “In order to maximize reimbursement, Select-Madison intentionally retained patients for longer than necessary to increase profit.” Under Medicare’s reimbursement structure, care for a patient who stays at a long-term acute care hospital, or LTACH, for a period between one day up to 5/6ths of the average length of stay is reimbursed at a lower rate than patients staying for the full average length of stay. Federal regulations require acute care hospitals to have an average length of stay for Medicare patients of at least 25 days to keep an LTACH certification. Schmadl alleges the hospital extended patient stays through the use of dangerous and medically unnecessary treatments and procedures. As an example, Schmadl’s complaint says, patients on ventilators would intentionally receive more oxygen support than necessary, making it harder to wean them from the ventilator and thus increasing the length of their hospital stay. During a patient’s stay, Schmadl also alleges, the hospital would routinely bill the government for services the patient never received, like the changing of wound dressings or respiratory treatments, to further increase reimbursement rates. The complaint also claims procedures such as X-rays or complete blood counts were routinely ordered in situations where those diagnostic tests had no medical necessity. Although Select-Madison would allegedly increase patient stays to maximize reimbursement, the suit claims, the hospital would also forcibly discharge patients whose length of stay extended beyond the maximum number of days for which the government would reimburse costs, even if a discharge presented significant medical risks. “Select-Madison would take aggressive steps to discharge patients from service even when discharge was not medically appropriate,” the complaint states. “Select-Madison took these steps in order to falsely obtain government payments, as a patient who stayed in excess of the average length of stay would no longer generate additional revenues for Select-Madison.” Reimbursements from Medicare and Medicaid accounted for over 50 percent of Select-Madison’s net operating revenue from health care services in 2011, according to the complaint. Schmadl’s suit is part of a growing number of FCA claims related to allegedly fraudulent Medicare and Medicaid billing practices. On July 21, Humana Inc. asked a Florida federal judge to toss a whistleblower suit brought by a physician under the FCA accusing the insurer of submitting fraudulent claims for payment through the Medicare Advantage program. Earlier this year, a complaint was unsealed in California federal court that alleged managed care provider Aveta Inc. had committed rampant fraud and collected as much as $350 million annually in unjustified Medicare Advantage payments by manipulating risk adjustment scores. Attorneys for the plaintiffs and a representative for Select Medical did not immediately respond to a request for comment on Wednesday. The plaintiff is represented by Nola J. Hitchcock Cross, Noah Reinstein and Mary C. Flanner of Cross Law Firm SC. Defense counsel information was not immediately available on Wednesday. The case is United States of America and the State of Wisconsin ex rel. Todd Schmadl v. Select Medical Holdings Corp. and Select Specialty Hospital-Madison Inc., case number 3:13-cv-00502, in the U.S. District Court for the Western District of Wisconsin. --Editing by Jeremy Barker. Related Articles Ky. Hospital Sues HHS Over Medicare Pay Rates For Needy Texas Hospital Group Pays $8M To Settle Medicare FCA Suit Printable Version Rights/Reprints Editorial Contacts Related Sections Employment Government Contracts Health Case Information Case Title United States of America et al v. Select Medical Holdings Corporation et al Case Number 3:13-cv-00502 Court Wisconsin Western Nature of Suit Other Statutes: False Claims Act Judge James D. Peterson Date Filed July 17, 2013 Companies Humana Inc. Select Medical Holdings Corp. Most Read Call For Participants: Law360s 2015 Editorial Advisory Boards Baker Botts Sued By Would-Be Client Over Email Disclosure Firms Hesitant To Hire New Associates Despite Work Increase 2nd Circ. 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Posted on: Fri, 23 Jan 2015 23:48:56 +0000
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