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JANUARY  2013

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by Todd South
timesfreepress.com


THE STORY SO FAR

In 2008 two former employees in separate cases filed whistle-blower lawsuits alleging that Life Care Centers of America was providing excessive therapies to Medicare patients to increase reimbursements.

Glenda Martin, a registered nurse and former staff development coordinator at the company's Morristown location, and Tammie Taylor, a former occupational therapist at the company's Lauderhill, Fla., site, are listed as the whistleblowers in the case.

Both lawsuits have been consolidated and had remained sealed with closed hearings until the Chattanooga Times Free Press requested the files and hearings be opened in September. U.S. District Judge Harry S. "Sandy" Mattice agreed to open the case in November.

Life Care has more than 200 facilities in 28 states with 38,000 employees and $2.69 billion in annual revenue, according to a 2011 Forbes.com report.

From 2006 until 2011 the company received $4.2 billion in Medicare reimbursements, according to court documents.

Source: Federal court documents


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Federal prosecutors allege that a widespread Medicare fraud scheme at Life Care Centers of America began at the highest levels of the corporate hierarchy and that employees who complained about possibly illegal practices were "ignored," "chastised," "punished" or fired.

Recently unsealed court records in an ongoing whistle-blower lawsuit against the Cleveland, Tenn.-based company reveal claims that the company founder and sole shareholder, Forrest Preston, forbade his own compliance department from conducting unannounced inspections at facilities.

Prosecutors claim that former Chief Operating Officer Cathy Murray circumvented the department's responses to employee complaints while she "aggressively drove the company's push for increased Medicare revenue."

"As [Murray] frequently told her employees, 'their job was to make money for Forrest Preston,'" according to court documents.

Murray could not be reached for comment Friday.

If found guilty on the fraud charges, Life Care could face fines in the hundreds of millions of dollars. Each fraudulent report carries a $5,000 to $11,000 fine, and prosecutors have asked the judge to triple the damages.

Company representatives have declined to comment on the allegations and referred questions to a Nov. 30 letter issued after the lawsuit became public.

"Contrary to the government's allegations, Life Care's therapy programs improve patients' conditions and their quality of life," the statement reads. "This belief is supported by medical literature, studies, and Life Care's first-hand experience in observing the progress of patients who receive high-intensity therapy."

Life Care is the nation's largest private nursing home company with more than 200 facilities in 28 states. From 2006 to 2011 Life Care received $4.2 billion in Medicare reimbursements.

Joe Carcello, director of research for the University of Tennessee's Corporate Governance Center, said management practices for private health care companies are similar to other for-profits but differ in some important ways.

Carcello likened increasing revenues for many businesses to someone shopping at the mall. A salesperson at a clothing store may sell a customer more clothes than he or she needs, but there's no ethical obligation on the staff -- the customers are responsible for their purchasing decisions.

Not so with Medicare.

"The payer for this is not the patient; the payer for this is the federal government," Carcello said. "In health care there are ethical obligations established by medical ethics embedded in state law and medical licensing codes that require medical care to be performed in the best interest of the patient."

The beginning

In 2005, Preston, Murray and Michael Reams, senior vice president of Rehabilitation Services, formed the "Rehabilitation Opportunity Committee" to increase Medicare revenues through higher therapy treatment levels and more days spent in their facilities, according to court documents.

Medicare reimburses therapies for patients in the first 100 days of care at five levels. Ultra High is the highest level and can pay a provider as much as $564. The lowest rate of therapy pays $231.

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The People News
PO Box 3921
Cleveland TN. 37320
(423) 559-2150  Fax 559-1044

Pete Edwards, Editor - Publisher

Ashley Murphy, Assitant Editor
Copyright 2013 (All rights reserved)

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The People News is adding something new. We wanted to expand our website in order to give you, the reader, a voice about local happenings. Of course, if your thoughts involve state, national, or international issues then we want to hear those as well!

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