United States Settles False Claims Act Case with SavaSeniorCare

United States Settles False Claims Act Case with SavaSeniorCare

The United States announced the settlement of a False Claims Act case against SavaSeniorCare, SavaSeniorCare Administrative and Consulting, and SSC Equity Holdings (Sava), originally filed by whistleblowers in four separate cases (three in Tennessee and one in Pennsylvania).[1] The settlement regards Sava billing Medicare for unnecessary rehabilitation services and for providing worthless services to residents.[2]  The privately-held Georgia-based company will pay the Federal Government $11.2 million (“plus additional amounts if certain financial contingencies occur”) and has signed a five-year chain-wide Corporate Integrity Agreement[3] with the HHS Office of Inspector General, covering 124 facilities in 12 states that are identified by name and state in Exhibit A to the Settlement.[4]

It has signed, or will sign, separate settlement agreements with certain states related to the submission of false Medicaid claims.

Medicare Billing

Between October 2008 and September 12, Sava “knowingly submitted false claims for rehabilitation therapy services as a result of a systematic effort to increase its Medicare billings.”  Through corporate-wide policies, “Sava exerted significant pressure on its SNFs to meet unrealistic financial goals, resulting in the provision of medically unreasonable, unnecessary or unskilled services to Medicare patients.”   The company “set these aggressive, prospective corporate targets for the highest Medicare reimbursement rates without regard for its patients’ actual clinical needs and then pressured its staff to meet those targets.”   The Government alleged that facilities delayed discharge of patients in order to bill Medicare.

Worthless Services

Between January 2008 and December 2018, Sava also “knowingly submitted false claims for payment to Medicare and Medicaid for grossly and materially substandard and/or worthless skilled nursing services.”  The Government alleged that Sava facilities failed to have sufficient staff, “failed to follow appropriate pressure ulcer protocols and appropriate falls protocols, and failed to appropriately administer medications to some of the residents.”

The Settlement Agreement, which is attached to the News Release, recites that in consideration of the payment and Corporate Integrity Agreement, the United States will not seek exclusion of SavaSeniorCare from the Medicare and Medicaid programs.  (Settlement ¶6.)

Corporate Integrity Agreement

The 45-page Corporate Integrity Agreement requires Sava to develop a compliance program.  An independent Monitor, to be appointed with 60 days of the settlement, will monitor the facilities’ compliance.  Sava facilities must report deaths or injuries resulting from restraints, psychotropic drugs, and abuse/neglect to the Monitor.

The Staffing Provision requires that Sava’s Compliance Committee assess and make recommendations to improve Sava’s nurse staffing.  The Committee must consult with nurse managers, facility nurses, and the Independent Monitor about staffing and must review the development and implementation of the staffing-related policies and procedures on an on-going basis to determine whether Sava facilities provide nursing staff necessary to meet residents’ needs.

Conclusion

The Corporate Integrity Agreement presents additional oversight of Sava facilities across the country.  However, additional public information about the Corporate Integrity Agreement and the 124 facilities it covers could help ensure that the Sava facilities fully comply with the Agreement and provide residents with the quality care they need.

The Center for Medicare Advocacy will try to identify the Monitor (the Inspector General does not publicly disclose the identity of Monitors) and will recommend to the Centers for Medicare & Medicaid Services that it identify, on Care Compare, the 124 facilities that are subject to the Sava Corporate Integrity Agreement.

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[1] The whistleblower cases are United States ex rel. Hayward v. SavaSeniorCare, LLC, et al., No. 3:11-cv-0821 (M.D. Tenn.); United States ex rel. Scott v. SavaSeniorCare Administrative Services, LLC, 3:15-cv-0404 (M.D. Tenn.); United States ex rel. Kukoyi v. SavaSeniorCare, LLC, et al., No. 3:15-cv-1102 (M.D. Tenn.); and United States, et al. ex rel. Thornton, et al. v. SavaSeniorCare, Inc., et al., Civil Action No. 16-CV-0840 (E.D. Pa.)
[2] United States Department of Justice, “SavaSeniorCare LLC Agrees to Pay $11.2 Million to Resolve False Claims Act Allegations; Allegations Include Medically Unnecessary Rehabilitation Therapy Services and Grossly Substandard Skilled Nursing Services” (News Release, May 21, 2021), https://www.justice.gov/opa/pr/savaseniorcare-llc-agrees-pay-112-million-resolve-false-claims-act-allegations 
[3] Sava Corporate Integrity Agreement, https://oig.hhs.gov/fraud/cia/agreements/SavaSeniorCare_LLC_and_SavaSeniorCare_Administrative_and_Consulting_LLC_052121.pdf
[4] https://www.justice.gov/opa/press-release/file/1396991/download.  Exhibit A to the Settlement identifies the 124 facilities in 12 states that are covered by the Settlement.  Sava’s website identifies 154 facilities in 18 states, https://savaseniorcare.com/find-a-center.htm