A multi-facility skilled nursing operator has filed a lawsuit against the staffing platform Nursa, alleging the app-based agency routinely overbilled for staff that failed to show up for shifts and refused to investigate nursing homes’ claims to that effect.
Nursa had sought nearly $5 million in payments from Oxford Valley Health, a skilled nursing provider with three facilities in Arizona and Nevada.
In a counterclaim filed March 15 and shared with McKnight’s Long-Term Care News Wednesday, Oxford alleges that Nursa broke its contract by significantly overbilling, refusing to reimburse the nursing home for unworked shifts and using a quick-turnaround review structure that limited billing challenges.
“Nursa’s scheme puts Oxford and other similarly situated healthcare facilities in the impossible position of having to choose to either (i) expend significant resources away from its core business operations to engage in the grueling process of challenging thousands of line-by-line billing entries … or (ii) submit to Nursa’s aggressive collection demands and threat of litigation and pay the full amount of the invoice, knowing that a substantive portion of invoiced work was not rendered,” reads the lawsuit, filed in the US District Court for the District of Utah, Central Division.
‘Impossible’ verification process
Oxford early on raised concerns about a 48-hour verification review process. According to the lawsuit, that requires a facility to review and verify shift reports upon submission from a clinician. If that’s not done within 48 business hours, the parties are deemed to have accepted any auto-verified shift reports.
Oxford argued it was “impossible to comply with the requirement, given the volume of Nursa’s overbilling and questionable shift reports.”
“Nursa intentionally designed this verification and billing structure in such a way as to harm Oxford and the hundreds of other similarly-situated healthcare facilities using Nursa’s services,” according to the lawsuit.
A public relations representative for Nursa did not respond to McKnight’s request for comment Wednesday.
Oxford attorney Andrew Kosowsky told McKnight’s Wednesday that the company isn’t disputing the entire $4.8 million Nursa seeks to collect, which includes an unpaid principal of $4.2 million plus late fees. Instead, it wants a venue where it can argue for relief on overbilling and reduce the debt — and possibly collect damages.
Like many providers, Oxford found itself with an increasing reliance on agency staff by late 2022. The company started using the Nursa software to hire gig workers when it became “desperate to staff our facilities so that we could maintain our high level of patient care,” Kosowsky said.
“As alleged in the lawsuit, we, like so many others, feel taken advantage of by the likes of Nursa, who threatened to, and then did, cut off our access to their service once we raised our concern about substantial overbilling,” he added.
Oxford alleges that Nursa breached its contract by:
- Charging for healthcare services that were not rendered
- Overcharging for cancellations and urgent booking well above a reasonable market rate
- Refusing to reimburse for healthcare services that Nursa knew, or should have known, were not rendered; and
- Failing to investigate whether it charged for healthcare services that were not rendered, despite receiving written notice.
Class status could open case to hundreds of clients
Oxford has asked the court to give the lawsuit class standing, opening it up to what Nursa describes as a 1,300-client base. Kosowsky said several facilities had already joined, and that “several more” are in the process of joining. He believes litigation “is likely the only way to force Nursa to stop these overbilling practices.”
While the company has worked with other staffing agencies, he said it have never experienced such expansive billing discrepancies or a refusal to work through them. In a two-month review of bills cited in the lawsuit, Oxford claims that it found 33% of some 600 job shifts it was billed for that had no record of a worker ever showing up.
“A substantial portion of the job shifts did not have any clock in/out records, or any other form of documentation to substantiate that the clinician performed the work during the invoiced shifts,” Oxford stated, telling the court it can also produce video records from its facilities to verify workers were not on scene or did not fill full shifts.
Kosowsky said Oxford has minimized its reliance on agency staff and offered tips Wednesday to others still needing to outsource hiring.
“It is important to spend time at the outset to perform due diligence on any new staffing agency, and do not assume that they have good billing practices,” he said. “Lastly, try as much as possible to avoid agencies when you can. Doing staffing internally/in-house will always be the best, and least expensive, option.”
