Long term care and rehabilitation provider Vibra Healthcare LLC (Vibra) has agreed to pay $32.7 million to resolve claims that it fraudulently billed Medicare for unnecessary services. The government alleged that between 2006 and 2013, Vibra admitted numerous patients to five of its long term care hospitals and to one of its inpatient rehab facilities who did not demonstrate signs or symptoms that would qualify them for long term care or inpatient rehab. Moreover, Vibra allegedly ignored its own clinicians recommendations to discharge patients and extended the stays of its long term care patients without regard to medical necessity, qualification and/or quality of care.
Part of the allegations resolved by this settlement were originally filed under the qui tam provisions of the False Claims Act by Sylvia Daniel, a former health information coder at Vibra Hospital of Southeastern Michigan. Under the qui tam provisions of the False Claims Act, whistleblowers with information about fraud against the government may bring a case on behalf of the United States. If successful, the government can recover three times the amount the defendants fraudulently billed the government. The whistleblower, who originally filed the case, is entitled to 15-30% of the government’s recovery as well as their attorney’s fees. Ms. Daniel will receive at least $4 million out of the government’s $32.7 million settlement.
Along with agreeing to pay $32.7 million, Vibra also agreed to enter into a chain-wide corporate integrity agreement with the Inspector General of the U.S. Department of Health and Human Services. Vibra operates approximately 36 freestanding long term care hospitals and inpatient rehabilitation facilities in 18 states.
“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). “OIG is committed to protecting precious Medicare dollars and ensuring that beneficiaries receive quality, necessary long term care.”