Melissa Jampol Quoted in “In FCA Complaint, DOJ Alleges LTCHs Kept Patients Regardless of Medical Necessity”

Melissa L. Jampol, Member of the Firm in the Health Care & Life Sciences and Litigation practices, in the firm’s New York office, was quoted in COSMOS Report on Medicare Compliance, in “In FCA Complaint, DOJ Alleges LTCHs Kept Patients Regardless of Medical Necessity,” by Nina Youngstrom.

Following is an excerpt:

DOJ: Hospital Gave Physician a PlayStation

Medicare pays LTCHs, which treat medically complex patients who require long hospital stays, partly based on their length of stay. According to the complaint, the hospitals allegedly kept patients who were ready for discharge because they earned more from Medicare when patients stayed 5/6ths of the average length of stay (ALOS). The LTCHs allegedly discharged the patients as soon as the financial advantage evaporated. “This scheme had a marked effect on the discharge timing of Medicare patients at the LTCH Defendants,” the complaint alleged.

Some patients were admitted by Newsom, who had generous medical director agreements with Riverside Hospital. The hospital paid Newsom $450,000 under three medical directorships from 2017 to 2022, allegedly to induce referrals, according to the complaint. The hospital also gave Newsom gifts, including a PlayStation 4, “for all of the referrals.”

The complaint is “a notice to the LTCH world to pay attention,” said attorney Melissa Jampol, with Epstein, Becker & Green. She thinks DOJ is taking a stand, “saying, look, we are concerned there could be potential manipulation of the length of stay.” But the complaint is only the government’s side of the story. “There’s another side that remains to be told,” Jampol said. Part of the government’s tale is told with data analytics, such as the discharge timing of patients. Jampol wonders whether there are other ways to interpret the data. “Data analytics are a starting point, not an ending point.”

Whistleblower Was Former COO

The FCA case against PHG and the other defendants was set in motion in 2020 by a whistleblower, Michaela DeVos, former chief operating office and nursing director at Riverside Hospital. Whistleblowers increasingly come from senior leadership ranks, Jampol said. “Folks we never saw being relators become relators when they get frustrated with their perceived problems,” she noted. It’s another reason for an effective compliance system “that makes people feel comfortable” reporting problems and “doesn’t just pay them lip service,” Jampol said. The whistleblower complaint and DOJ’s complaint don’t mention a compliance program, and attorneys for the whistleblower didn’t respond to RMC’s questions. …