How to Report Long Term Acute Care Hospital Fraud (LTCH or LTACH fraud) and Receive a Whistleblower Reward
This article addresses how to report Long Term Acute Care Hospital fraud (LTCH or LTACH fraud) and receive a whistleblower reward.
Medicare pays long term acute care hospitals on a prospective payment system (PPS). That means Medicare pays a fixed or set price to long-term acute care hospitals (LTCH/LTACH). Because patients staying long term at a hospital can cost more than the stay for patients at general hospitals, Medicare pays a higher rate to LTCH/LTACH’s, provided they meet the requirements of being a long-term acute care hospital. Specifically, the LTCH/LTACH must have an average inpatient length of stay for Medicare patients greater than 25 days. Long term acute care hospitals that fail to exceed the 25 day rule for Medicare patients must repay Medicare the higher rates.
How to Report LTCH/LTACH Fraud pertaining to Extending Stays
Many long term acute care hospitals engage in fraud schemes by cheating to make it appear they meet the 25 day average stay. In short, some LTCH/LTACH keep many patients longer than medically necessary just to pad their numbers of days. For instance, administrators purposefully delay in creating discharge plans. Some LTCH/LTACH’s may even lie to family members, claiming the doctor wants them to stay a few more days. These LTCH/LTACH’s also delay in contacting nursing homes or hospice facilities where the patient is suppose to go just to keep them longer in their hospital.
How to Report LTCH/LTACH Fraud pertaining to Interrupted Stays
Other long term care hospitals engage in fraud schemes by circumventing the “interrupted stay” regulation, which does not pay LTCH/LTACH’s more funds if they discharge patients for less than 10 days before readmitting them. The purpose of this rule is to prevent LTCH/LTACH’s from transferring a patient to another provider just to bring them back so they can bill more. For instance, suppose Jane Doe is admitted to a LTCH/LTACH for an illness that will keep her in the hospital for 30 days. (Note: a LTCH/LTACH does not get paid for days after the allowed length of stay. But if after 10 days away, it can readmit the patient and keep billing.) If on day 28, Jane develops a condition requiring intensive care, she is properly transferred to an ICU at another hospital. Assume Jane gets better in 8 days and should go back to the LTCH/LTACH. But, the LTCH/LTACH will not get paid more if she returns in less than 10 days, so the LTCH/LTACH blocks the admission by stalling and refusing to allow the patient to be transferred back until 10 days passed. This is fraud, and the LTCH/LTACH must repay the extra billing submitted to Medicare.
Damages and Whistleblower Rewards for reporting LTCH/LTACH Fraud
If an LTCH/LTACH routinely commits these types of fraud over the course of a few years, the damages to Medicare can be in the millions of dollars. The U.S. Department of Justice has a whistleblower reward program that will pay you between 15% and 30% of what it recovers back from a hospital or healthcare provider that cheats Medicare or Medicaid. You will need to have an attorney file the application for you, and they will take the case on a contingency fee so you will not need to spend a dime to seek a reward. Fraud by LTACH’s is now on the radar screen of the government and it wants you to report it and collect a sizeable reward.
Mr. Hesch has filed several whistleblower reward applications for those asking him how to report Long Term Acute Care Hospital fraud (LTCH or LTACH fraud). In one case, the whistleblower received over $12 million as a reward.
Find out if Mr. Hesch can help you answer the question of how to report Long Term Acute Care Hospital fraud (LTCH or LTACH fraud) and receive a whistleblower reward.
See the link below “Do I have a case” to have Mr. Hesch review your case. See the link below “Report Fraud” to learn more about the government’s whistleblower reward program.
Click on this link for a pdf version of this article, Reporting LTCH or LTACH fraud for a reward