United States and Tennessee Recover $9.5 Million from Diversicare LLC for False Medicare and Medicaid Claims

Diversicare submitted false claims for unnecessary rehabilitation therapy at its skilled nursing facilities

NASHVILLE, TENNESSEE / ACCESSWIRE / February 28, 2020 / Anna C. Dover of Kreindler & Associates and Michael Hamilton of Provost Umphrey Law Firm LLP today announced a coordinated effort by the Civil Division of the Department of Justice, the U.S. Attorney's Office for the Middle District of Tennessee, the Office of Inspector General of the Department of Health and Human Services, and the Tennessee Bureau of Investigation resulted in a $9.5 million settlement with Diversicare LLC (based on Diversicare's ability to pay) in two newly-unsealed healthcare fraud whistleblower actions, the first of which was handled by Ms. Dover and Mr. Hamilton. Diversicare, a group of affiliated entities based in Franklin, Tennessee, has operated as many as approximately 74 skilled nursing facilities in a number of states. Of the $9.5 million recovery, $7.695 million was allocated to Ms. Dover's and Mr. Hamilton's client's first-filed False Claims Act action.

Ms. Dover and Mr. Hamilton represented the whistleblower, or "relator," in the first-filed qui tam complaint, which was filed under seal on July 3, 2012 in federal court in the Middle District of Tennessee. Relator alleged that Diversicare's corporate policies resulted in the submission of false claims to Government healthcare programs for unnecessary rehabilitation therapy provided to patients at Diversicare skilled nursing facilities.

The government's investigation triggered by Relator's complaint further alleged that Diversicare submitted claims for Ultra High therapy levels despite evidence that (1) the frequency and duration of physical or occupational therapy were not reasonable or necessary for the patient, (2) the intensity of the physical or occupational therapy was inappropriate for the patient and not reasonable or necessary, (3) services did not require the skills of a therapist to perform them, and (4) speech therapy was medically unnecessary. Based on their investigation, the government also alleged that Diversicare submitted forged, photocopied, or pre-signed physician signatures on pre-admission evaluation certifications required for TennCare (Tennessee's Medicaid program) claims submissions. Diversicare also agreed to a five-year Corporate Integrity Agreement (CIA) with the HHS-OIG as part of the settlement requiring, among other things, the implementation of a risk assessment and internal review process designed to identify and address evolving compliance risks.

"Our relator wasted no time in reporting the fraud she witnessed thus assisting the Government in ending a practice that cost the U.S. taxpayers millions of dollars," says her attorney, Anna C. Dover. "Special thanks to Assistant U.S. Attorney Sarah K. Bogni and Department of Justice Attorney Yolonda Campbell for their tireless efforts in bringing this long-running case to an excellent close."

Pursuant to False Claims Act provisions, the Relator will be awarded 18.5% of her allocated share of the Government's recovery. The settlement was handled by Assistant U.S. Attorneys Sarah K. Bogni of the U.S. Attorney's office of the Middle District of Tennessee and Yolonda Campbell of the Department of Justice as well as Philip Bangle of the Tennessee Office of the Attorney General and Relator's counsel Anna C. Dover of Kreindler & Associates and Michael Hamilton of Provost Umphrey Law Firm LLP.

CONTACT: Anna Dover | 646.488.5253 (direct) | adover@blowthewhistle.com

NOTE TO MEDIA: Copies of the complaint, settlement agreement and other materials are available upon request

SOURCE: Kreindler & Associates

ReleaseID: 578398