Brookdale Senior Living has requested that the U.S. Court of Appeals for the Sixth Circuit uphold the November dismissal of a former employee’s False Claims Act lawsuit against the company. The action came March 14 in response to an appeal filed by Marjorie Prather in February.
Prather, a registered nurse, originally brought the lawsuit against Brookdale in 2012, alleging that the company and some subsidiaries had submitted Medicare claims knowing that they were improperly certified for home health services and lacked medical necessity, and also that they improperly billed for assessments. The lawsuit was dismissed in March 2015, however, when a federal judge said that Prather did not allege “with particularity” that Brookdale submitted an actual false claim to the Medicare program. Prather’s subsequent refiling of the lawsuit also was dismissed, in November.
Court documents filed in Prather’s appeal indicate that she was part of a team responsible for reducing a backlog of 7,000 claims worth approximately $35 million. Prather maintained that Brookdale had signed up assisted living residents for therapy and home health services offered by subsidiaries, then found doctors who would say that the services were necessary. Prather said that she and others were pressured to speed up the claims review process so that claims could be submitted for payment from Medicare and that team members were told not to pay attention to potential compliance issues, which could impede the review process. Prather also maintained that employees were given bonuses based on the number of claims they processed, and that physicians were paid for the time they spent looking over and signing paperwork.
Brookdale said in its brief related to the appeal that Prather has not demonstrated that the doctors who signed the documents did not complete the work or prescribe the services that they said they recommended.