TN whistleblowers credited in $30M settlement of federal fraud complaint against nursing home chain

A nursing home chain with more than two dozen facilities in Tennessee has settled a $230 million Medicare fraud complaint with an agreement to pay a $30 million settlement, reports WPLN. Two women who worked at one of the facilities in Columbia are credited as key whistleblowers and will get $6 million.

LeeAnn Holt and Kristi Emerson, both of whom are occupational therapists from Columbia, collected reams of anecdotes — in part, because they were concerned they might get in trouble themselves.  That evidence is the basis of settlement announced late Friday between the federal government and Louisville-based Signature Healthcare, which operates more than 100 facilities in 17 states.

… The complaint against Signature Healthcare accuses the company of systematically administering occupational, physical and speech therapy when it wasn’t warranted and withholding care when government reimbursements were already maxed out. According to the suit, the unnecessary therapy pushed patients into a category where the facility was reimbursed more per day for those patients, often hitting precisely the 720-minute per week threshold for maximum payment.

As part of the $30 million settlement with the U.S. Department of Justice, the company has admitted no liability and denied the allegations. But in a statement, CEO Joe Steier says the payout “allows us to move forward in serving our residents.”

Emerson says she hopes the case will still inspire other health care workers to push back when they feel pressured to do procedures they deem medically unnecessary.

“We can’t just blame these corporations for all of this,” she says. “We have to shoulder as therapists some of the responsibility because we’ve allowed this to get this bad.”

Emerson and Holt were let go amid the investigation and have found it difficult to find stable work. “No one really wants a whistleblower in their building,” Emerson says.

But now they will split roughly $6 million as their share of the settlement. Whistleblowers are entitled to 15 percent to 25 percent of the total.

The lead lawyer is Jerry Martin, the former U.S. Attorney for Middle Tennessee.  As a prosecutor, Martin made prosecuting health care chains a priority, given the concentration in Nashville, and says he’s doing the same in private practice.

“We feel like we’re just getting started,” Martin says. “All these businesses — these health care companies — are dependent upon the government, the taxpayer money. That’s their business model.

“And so in exchange for that, you ought to be willing to accept a fair amount of oversight.”

Note: The Department of Justice press release on the settlement is HERE.