When politicians cannot agree how to reduce budget deficits, they always find common ground in campaigns to root out alleged fraud and abuse. Central to this budget fight will be the cost of Medicare. One point of agreement is that the Center for Medicare and Medicaid Services (CMS), the agency responsible for managing the program, has done an abysmal job of maintaining a healthcare system that reduces fraud. While the CMS attempts to discover how to investigate fraud, the Department of Justice (DOJ) is not waiting and has committed itself to investigate and prosecute alleged fraudulent schemes, targeting fraud in overpayments to Skilled Nursing Facilities (SNFs).
In November of 2012, the United States Department of Justice intervened in a qui tam action (filed under the federal False Claims Act or "FCA") against Life Care Centers of America, a large operator of skilled nursing facilities. The suit was originally filed in 2008 by Glenda Martin, a registered nurse and former staff development coordinator for Life Care. In its complaint, the government alleged a system wide effort by management to defraud Medicare though overbilling for skilled therapy. The government accused the owner and senior management of Life Care of using a combination of coercion and incentives to pressure therapists to provide either unnecessary or excessive therapy and delay the discharge of patients to justify ever-increasing charges to Medicare. Management was also accused of actively thwarting the efforts of Life Care's own compliance staff to prevent the abuses that were occurring.
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