Consulate Wins Lengthy Court Battle After Judge Denies Billing Lawsuit
Patrick Connole
1/17/2018
Consulate Health Care will not
have to pay a $347 million False Claims Act judgment from last March after a
federal judge in Florida on Jan. 11 tossed that decision, denying a whistleblower
lawsuit that alleged skilled nursing facilities under a previous owner had
overcharged the Medicare and Medicaid programs through inflated therapy claims.
The case, Ruckh v. CMC, centered on allegations by former part-time agency
employee Angela Ruckh, who claimed that Consulate acted illegally in filing
claims for government reimbursement. U.S. District Judge Steven Merryday in
rejecting the March judgment not only denied the validity of Ruckh’s
allegations, but also relied heavily on the U.S. Supreme Court’s June 2016
ruling in Universal Health Services v.
Escobar.
The Supreme Court ruling clarified
that a False Claims Act claim is not proven true just because a contractor
submits a claim for payment with technical deficiencies in its paperwork.
In his decision, Merryday
said the “relator,” or whistleblower Ruckh, “offered no meaningful and
competent proof that the federal or the state government” would, even if they
had known of the disputed practices, refused to pay the defendants’
reimbursement claims.
“Not only did the relator
fail to prove that the governments regarded the disputed practices as material
and would have refused to pay, but the relator failed to prove that the
defendants submitted claims for payment despite the defendants’ knowing that
the governments would refuse to pay the claims if either or both governments
had known about the disputed practices,” he said.
The judge said the facts
show both the federal and state governments were, and are, aware of the providers’
disputed practices and allegations of wrongdoing, “but neither government has
ceased to pay or even threatened to stop paying the defendants for the services
provided to patients throughout Florida continuously since long before this
action began in 2011. For these and for each of the other reasons argued by the
defendants, the judgments cannot stand.”
Consulate, in applauding the
court’s decision to throw out the March judgment, stressed that its company didn’t
actually own the facilities at the time the billing practices were brought into
question. A company called Seacrest Management operated the buildings in which
Ruckh made her allegations, and were later folded into Consulate after a
merger, according to Daniel Dias, chief corporate counsel for the provider.
In fact, Ruckh hadn’t worked for Consulate,
since Consulate did not come into existence until 2012 and the allegations
center around the two previous years. Having inherited the issue of Ruckh’s
allegations, Dias says the company has fought a long, more than five-year
battle to refute the charges and feels vindicated by the Merryday decision.
“This was not about Consulate
Health Care. We have been, however, litigating this matter since 2012, so it
has been a pretty aggravating process since it is not our claims in question,
not our issue, and none of the allegations are about us. We have spent a lot of
time, money, and effort to defend the case, and we certainly, nevertheless,
have felt very strongly about our arguments all the way through,” he says.
In assessing the Merryday ruling,
Dias says the long term and post-acute care profession should be aware of the
significance of his words on both the Escobar
front and how the court views the actions at the facility level versus the
management level of an operation.
Unlike most False Claims Act
cases Dias says he has ever heard of, the Ruckh
arguments went beyond claims of fraudulent practices resulting from overbilling
or the providing of unnecessary services. “This case went further, and got into
the technical compliance with the Requirements of Participation,” he says.
Likening the allegations of
wrongdoing to that of a police officer failing to sign a ticket properly, Dias
says the minute corrections that were cited by Ruckh, if allowed to stand, would “have had a potentially chilling
effect on our industry or any industry.”