United States v. KINDRED HEALTHCARE, INC.

District Court, E.D. Pennsylvania·Decided October 7, 2024·No. 2:16-cv-00683·Unknown

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA UNITED STATES, et al., ex rel., TIMOTHY CIVIL ACTION SIRLS, Plaintiffs, NO. 16-0683-KSM v. KINDRED HEALTHCARE, INC., et al., Defendants.

MEMORANDUM Marston, J. October 7, 2024 Relator Timothy Sirls brings this qui tam action on behalf of the United States under the False Claims Act (“FCA”) and on behalf of ten states1 under analogous state statutes. (See Doc. No. 62.) He alleges that Defendant Kindred Healthcare, Inc. and six other Defendant Kindred entities (collectively, “Kindred”)2 wrongfully accepted Medicare and Medicaid reimbursements for services that Kindred failed to provide residents at its nursing facilities. (Id.) I. BACKGROUND Because the Court writes only for the parties, we do not recite the facts and procedural history at length in this Memorandum.3

1 Those states are: Colorado, Georgia, Indiana, Massachusetts, Montana, Nevada, North Carolina, Virginia, Washington, and Wisconsin. (Doc. No. 62.) Relator previously voluntarily dismissed claims brought on behalf of New Hampshire (Doc. No. 61 at 2), and the Court previously dismissed with prejudice the claims asserted on behalf of California, Connecticut, and Tennessee (Doc. No. 86). 2 The six other Defendant entities are: Kindred Healthcare Operating, Inc., Kindred Healthcare Services, Inc., Kindred Nursing Centers East, LLC, Kindred Nursing Centers West, LLC, Kindred Nursing Centers South, LLC, Kindred Nursing Centers North, LLC. (Doc. No. 62.) 3 A more detailed discussion of the facts and procedural history can be found in the Court’s Memoranda deciding Kindred’s motions to dismiss. See U.S. ex rel. Sirls v. Kindred Healthcare, Inc., A. Factual Allegations From April to July 2014, Relator worked as the Director of Nursing Services at Heritage Manor Healthcare Center in Mayfield, Kentucky. (Doc. No. 62 at ¶ 7; id. at p. 95.) During the relevant period, Heritage was one of 174 nursing facilities operated by Kindred across the country. (Id. at p. 2.) Relator claims that at each of these facilities, Kindred purposefully

recruited residents with high acuity levels (i.e., residents who were extremely dependent on staff for their most basic care needs) so that it could reap higher Medicare and Medicaid reimbursements from the named government entities. (Id. at ¶¶ 2, 6, 7.) Kindred then purposefully understaffed the facilities so that it could see a higher profit from those reimbursements. (Id.) Specifically, Relator alleges that Kindred instituted a strict policy of staffing based on census (number of residents) and not on acuity (resident needs). (Id. at ¶¶ 2, 6, 7, 65.) This understaffing meant it was “humanly and mathematically impossible” for the nursing facilities to deliver the essential care services that Kindred claimed were needed by its residents and—more importantly—that it claimed were provided to those residents. (Id. at ¶¶ 2, 5, 6.)

The FCA “punishes the knowing presentation of a fraudulent demand for payment to the United States, and permits a private relator to bring a qui tam civil suit in the government’s name.” U.S. ex rel., Zizic v. Q2Administrators, LLC, 728 F.3d 228, 231 (3d Cir. 2013) (citations omitted). Here, Relator has three sets of remaining claims: (1) claims based on the alleged factual falsity of claims submitted under the FCA and analogous state laws, (2) claims based on the alleged express false certifications of accuracy in Minimum Data Set forms, and (3) claims

469 F. Supp. 3d 431, 438–42 (E.D. Pa. 2020) (“Kindred I”); U.S. ex rel. Sirls v. Kindred Healthcare, Inc., 517 F. Supp. 3d 367, 374–78 (E.D. Pa. 2021) (“Kindred II”). based on the alleged express false certifications of accuracy in Form CMS 1500s. Kindred II, 517 F. Supp. 3d at 391. This motion involves the first set of claims. Relator’s factual falsity claims relate to the Minimum Data Set (“MDS”) forms that Kindred’s nursing facilities completed for each resident in their care. (See Doc. No. 62 at ¶ 10.)

On each resident’s MDS form, in “Section G,” the relevant Kindred facility described that resident’s ability to perform activities of daily living (“ADL”), including bed mobility, toilet use, and eating, as well as the level of staff assistance required by and provided to the resident in performing these tasks. (Id. at ¶ 34 (“In Section G of the MDS, the nursing home provides a specific list of the ADL care each resident needs and a list of the AOL [sic] services the nursing home claimed to have provided to the resident.”); see also id. at ¶¶ 35–36.) Section G is used to determine the resident’s Resource Utilization Group (“RUG”) score, which in turn affects the amount of Medicare and/or Medicaid reimbursement that the facility receives. (Id. at ¶¶ 135– 41.) Relator argues that from February 2008 to the present, Kindred knowingly submitted

false MDS forms (in that the facilities could not and did not provide the ADL services that they claimed were needed and provided), and therefore, submitted claims for reimbursement that were factually false. (See Doc. No. 62 at ¶ 7.c. (“Kindred’s systemic, non-acuity-based staffing practices resulted in dependent residents routinely not receiving the essential ADL care that Defendants certified such residents required and were provided and which directly resulted in resident neglect and harm.”); id. at ¶ 7.e (same); id. at ¶ 8 (“Relator has direct knowledge that Kindred understaffed each of the subject nursing homes and quantified the extent to which it deprived residents of the basic ADL care that was required and that Kindred claimed was provided.”); id. at ¶ 136 (“Accordingly, insomuch as these MDS ADLs are used to classify each resident into different case-mix categories called RUGs, Kindred’s coding of residents’ needs and services provided directly influenced the amount of its Medicare and most Medicaid payments.”).) B. Procedural History Relator filed this qui tam action on February 11, 2016, and it was assigned to the

Honorable Jan E. Dubois. (Doc. No. 1.) On April 3, 2019, the government entities declined to intervene in the case (Doc. No. 15), and the Court ordered that the Complaint be unsealed and served on Kindred (Doc. No. 16). In the months that followed, Relator twice amended the Complaint, first on July 22, 2019, and again, on August 14, 2020. (See Doc. Nos. 18, 62.) As noted above, after multiple rounds of motion practice, the only claims remaining in the operative Second Amended Complaint are claims “based on the theories of factual falsity and express false certification of accuracy in MDS forms and Form 1500s” in Counts I, II, IV, V, VIII through XXI, and XXIV through XXIX. (Doc. No. 86 at ¶ 4.) 1. Early Discovery On April 30, 2021, this action was reassigned to the undersigned. (Doc. No. 114.) One

Free access — add to your briefcase to read the full text and ask questions with AI

United States v. KINDRED HEALTHCARE, INC., (E.D. Pa. 2024).

United States v. KINDRED HEALTHCARE, INC. (United States v. KINDRED HEALTHCARE, INC.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

United States v. R&F Properties of Lake County, Inc.
433 F.3d 1349 (Eleventh Circuit, 2005)
In Re: Rockefeller Center Properties, Inc. Securities Litigation, Charal Investment Company Inc., a New Jersey Corporation C.W. Sommer & Co., a Texas Partnership, on Behalf of Themselves and All Others Similarly Situated Alan Freed Jerry Crance Helen Scozzanich Sheldon P. Langendorf Rita Walfield Robert Flashman Renee B. Fisher Foundation Inc. Frank Debora Wilson White Stanley Lloyd Kaufman, Jr. Joseph Gross v. David Rockefeller Goldman Sachs Mortgage Co. Goldman Sachs Group Lp Goldman Sachs & Co. Whitehall Street Real Estate Limited Partnership v. Wh Advisors Inc. v. Wh Advisors Lp v. Daniel M. Neidich Peter D. Linneman Richard M. Scarlata Frank Debora Wilson White Stanley Lloyd Kaufman, Jr. Joseph Gross, Charal Investment Company Inc., a New Jersey Corporation C.W. Sommer & Co., a Texas Partnership, on Behalf of Themselves and All Others Similarly Situated Alan Freed Jerry Crance Helen Scozzanich Sheldon P. Langendorf Rita Walfield Robert Flashman Renee B. Fisher Foundation Inc. Frank Debora Wilson White Stanley Lloyd Kaufman, Jr. Joseph Gross v. David Rockefeller Goldman Sachs Mortgage Co. Goldman Sachs Group Lp Goldman Sachs & Co. Whitehall Street Real Estate Limited Partnership v. Wh Advisors Inc. v. Wh Advisors Lp v. Daniel M. Neidich Peter D. Linneman Richard M. Scarlata Charal Investment Company Inc. C.W. Sommer & Co. Renee B. Fisher Foundation Helen Scozzanich Jerry Crance Alan Freed Sheldon P. Langendorf Rita Walfield Robert Flashman
311 F.3d 198 (Third Circuit, 2002)
Thomas Foglia v. Renal Ventures Management
754 F.3d 153 (Third Circuit, 2014)
Castellani v. City of Atlantic City
102 F. Supp. 3d 657 (D. New Jersey, 2015)
Morrison v. Philadelphia Housing Authority
203 F.R.D. 195 (E.D. Pennsylvania, 2001)
Fort Washington Resources, Inc. v. Tannen
153 F.R.D. 78 (E.D. Pennsylvania, 1994)