Supportive Care: Facility Fees and Patients Who Had Left the Nursing Home
In the Supportive Care telehealth settlement, the companies and their CEO paid $4,595,739 to resolve allegations of improper nursing-home facility fees and psychological-service claims for patients already admitted to hospitals. The alleged discrepancies reach straight into a clinical coordinator’s or billing employee’s working day: who supplied the support at the nursing home, who billed for it, and where the resident actually was.
The Department of Justice announced the civil settlement on June 13, 2024. It covered Medicare and Connecticut Medicaid claims and alleged conduct from 2019 through 2023. Supportive Care provided psychological services to residents of skilled nursing facilities in Connecticut and other states. The Department of Health and Human Services’ Office of Inspector General investigated the matter, which the U.S. Attorney’s Office for the District of Connecticut handled.
What the Telehealth Originating-Site Facility Fee Pays For
The telehealth originating-site facility fee, billed as Q3014, pays for the eligible facility’s part in hosting the patient. It is separate from the professional fee for the clinician’s psychological service. The originating site is where the patient receives the remote service. The distant site is where the physician or other qualified professional delivers it.
That division matters in a nursing home. The clinician can be elsewhere while the facility supplies the administrative and clinical support for the resident’s visit. As the Justice Department explained in this case, the nursing home supplying that support was the party entitled to bill it.
This separation predates the pandemic. The Centers for Medicare & Medicaid Services’ November 2018 telehealth report described skilled nursing facilities among the eligible originating sites and the separate professional and facility payments.
What the Government Alleged
Facility Fees Billed by the Remote Provider
The government alleged that Supportive Care and its CEO submitted, or caused others to submit, Q3014 claims that should have been billed by the nursing homes.
The accusation puts the nursing home’s support work at the center of the bill. The facility hosted the resident and supplied administrative and clinical support, while the remote behavioral-health provider allegedly claimed the fee for that role.
Psychological Services Claimed After a Hospital Transfer
The government separately alleged that Supportive Care billed Medicare and Connecticut Medicaid for psychological services supposedly provided to nursing-home residents who had already transferred to hospitals and been admitted as inpatients.
The claim placed the patient in a nursing home. The government said that patient was in a hospital bed. Taxpayers were being asked to fund care described at a place the patient had already left.
For the employee who handled the transfer or the remote appointment, this is a discrepancy between the care they knew about and the care described to the payer. Their knowledge can connect a hospital admission to a bill that, viewed alone, still places the patient in the nursing home.
What Evidence Is Needed to Prove Fraud?
We work with an insider to connect the remote-service claim to the facility’s support and the resident’s location on the service date. A clinical coordinator or billing employee may know the care arrangements behind a charge, including who supplied the support or when the resident transferred. A health care employee who knows who directed the billing can help us connect a repeated discrepancy to decisions inside the company.
Medicare and state Medicaid programs have their own payment requirements, and telehealth rules changed during the pandemic. We examine the payer and service date with the insider so the billing is assessed under the rules that applied to that claim.
The Same Facility-Fee Question When the Patient Is Home
In its April 2, 2025 settlement announcement, the Justice Department alleged that Med-Surg Physician Group added originating-site facility fees to telehealth claims when the patients were at home. The announcement cited a West Virginia Medicaid clarification that the member’s home did not qualify for the fee.
Can You Get Money for Reporting Fraud?
A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.
You Know Where the Resident Was
If you arranged the remote visits, handled resident transfers or saw who billed the facility fees, speak with our whistleblower experts about the billing you saw. We put your understanding of resident care at the center of the case, find telehealth fraud whistleblower lawyers with the specific expertise your case needs, and stay your partners in building your strongest whistleblower case.
