Vibra Healthcare LLC (Vibra), a national hospital chain headquartered in Pennsylvania, agreed to pay $32.7 million to resolve False Claims Act (FCA) allegations that the company fraudulently billed Medicare for medically unnecessary services. Vibra operates 39 long term care hospitals (LTCHs) and inpatient rehabilitation facilities (IRFs) in 18 different states.
LTCHs provide inpatient hospital services for patients whose medically complex conditions require long hospital stays and programs of care. IRFs are intended for patients needing rehabilitative services that require hospital-level care.
The government alleged that between 2006 and 2013, Vibra admitted numerous patients to five of its LTCHs and to one of its IRFs who did not demonstrate signs or symptoms that would qualify them for admission. Moreover, Vibra allegedly extended stays of its LTCH patients without regard for medical necessity, qualification and/or quality of care. Allegedly, Vibra even ignored the recommendations of its own clinicians that patients were ready for discharge.
“Medical necessity is fundamental if health providers wish to claim taxpayer funds for medical care,” said Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG).
The qui tam provision of the FCA aids in detecting fraud by empowering individuals to blow the whistle. These individuals become whistleblowers as they file suit on behalf of the United States. Whistleblowers, also known as relators, are entitled to several incentives provided by the FCA. These incentives include protection against retaliation and 15 to 30 percent of the monies recovered by the government.
The case against Vibra was filed under the qui tam provision by Sylvia Daniel, a former health information coder at a Vibra hospital. Daniel will receive at least $4 million for her part in the case.
Are you aware of fraud being committed against the federal government, or a state government? If so, the FCA can protect and reward you for doing the right thing by reporting the fraud. If you have any questions about whether you qualify as a whistleblower, please contact an attorney at Beasley Allen for a free and confidential evaluation of your claim. There is a contact form on this website, or you may email one of the lawyers on our whistleblower litigation team: Archie Grubb, Larry Golston, Lance Gould or Andrew Brashier.
Source: U.S. Department of Justice