OnPoint Analytics

OnPoint Expert Testifies in False Claims Act “qui tam” Lawsuit Alleging Medicare Billing Fraud against Nursing Facilities

OnPoint expert Dr. Vivek Shah recently provided deposition testimony in a qui tam False Claims Act matter against certain Skilled Nursing Facilities (SNFs) accused of defrauding Medicare. The amount of therapy required by Medicare SNF beneficiaries affects their assignment to certain resource utilization groups (RUGs), which in turn determine the reimbursement rates that SNFs receive under Medicare for the care they provide to beneficiaries. The alleged fraudulent conduct by the SNFs at issue included an exaggeration of therapy minutes provided to beneficiaries during assessment periods in order to qualify for higher reimbursement rates, without intending to sustain those therapy minutes after assessment periods.

Dr. Shah served as an economic expert on behalf of the Relator, the United States Government and the State of Illinois. Dr. Shah submitted an initial expert report and an expert surrebuttal report wherein he assessed the extent of the alleged ramping up of therapy minutes and analyzed the economic damages allegedly suffered by the Centers for Medicare and Medicaid Services (CMS) as a result of the defendants’ purported fraudulent conduct.

To learn more about Dr. Shah, please click here.