A whistleblower’s allegations that a Florida skilled nursing facility billed Medicare for unnecessary therapy treatments and categorized patients into higher Resource Utilization Groups to get higher reimbursements is moving forward in federal court.
The U.S. District Court for the Middle District of Florida agreed to move forward with the case in a ruling issued Tuesday, Bloomberg Law reported. The federal government and former administrator Delia Bell are pursuing the case against the Miami-based Cross Garden Care Center.
They also accused the provider of “maximizing and resetting 100-day benefit periods” in order to increase reimbursement from Medicare.
The provider had sought to have the complaint dismissed, citing that it didn’t satisfy federal rules of civil procedure, the venue for the case was improper and that it didn’t have adequate notice of the claims made against them. The court, however, disagreed.
The court did dismiss one complaint against the provider. Bell had alleged that the facility created false narratives in patient notes to justify their decision to provide services in excess of what was medically necessary.
The court, however, found that the allegations weren’t adequate and dismissed the count. It also ruled that Bell has 20 days to file an amended complaint, the report stated.
