Supportive Care Holdings: Claims for Residents Who Were Somewhere Else

In the Supportive Care Holdings fraud case, the companies and their CEO paid $4,595,739 to resolve allegations of improper telehealth facility fees and psychological-service claims for nursing-home residents who were actually hospital inpatients. The allegations reach both ends of a remote visit: who could bill for supporting the patient at the nursing home, and whether the patient was there at all.

Supportive Care’s business included psychological services for people living in skilled nursing facilities in Connecticut and other states. The claims at issue went to Medicare and Connecticut Medicaid. A clinician, a billing employee and a nursing-home worker could each recognize a different part of these allegations. The fee dispute concerns the business requesting payment. The hospital-transfer allegation concerns the resident the claim says received care.

Q3014 and the Nursing Home’s Part of the Visit

Q3014 is the telehealth originating-site facility fee. For the visits at issue, it paid for the nursing home’s administrative and clinical support for a resident receiving telehealth services. It was an additional payment, separate from the professional fee for the psychological service itself.

The originating site was the patient’s end of the visit. The distant site was where the physician or other qualified healthcare professional provided the service. In the arrangement described by the government, the nursing home supplied the originating site, while the psychological-service provider supplied the professional care.

The government alleged that the Supportive Care companies and their CEO billed, or had others bill, Q3014 fees that should have been billed only by the nursing homes. The alleged problem concerned which business claimed the facility fee. Providing the psychological service did not make the provider the nursing facility supporting the resident at the other end.

We would want to connect the fee line to the entity that claimed it and the facility work it represented.

The government alleged that the business at one end of the visit claimed the fee reserved for the other. We call that billing for someone else’s work.

Claims for Residents Who Had Been Admitted to Hospitals

The government separately alleged that Supportive Care and its CEO billed for psychological services to nursing-home residents who had been transferred to hospitals and admitted as inpatients. According to the government, those beneficiaries were no longer living in the nursing homes where the claimed services supposedly took place.

This allegation puts the service date at the center of the case. The government alleged a hospital transfer and inpatient admission, a concrete event against which the claimed nursing-home encounter could be checked.

For a nursing-facility employee who knows the resident left, or a clinician who knows which visits took place, that difference is immediately recognizable. The question is what the bill says happened on the day the resident was somewhere else. A visit without the resident.

What Evidence Is Needed to Prove Fraud?

For allegations like these, the useful evidence connects the submitted claim to the service date, the resident’s actual location and the entity entitled to bill for the work. We would examine the encounter documentation alongside the nursing-home census or transfer record, the hospital admission and the professional and facility-fee claims. Each answers a different part of the question.

The nursing-facility side can explain whether the resident was present and what support the facility provided. The clinical side can explain the encounter. The billing side can show which organization submitted which fee. An insider knows how those accounts fit together, or exactly where they stop matching.

Wrong service dates and copied prior treatment notes were among the allegations in Oswego Hospital’s behavioral-health billing settlement. The government also alleged missing documentation and absent required time information. The shared problem is a claim whose treatment record does not account for the encounter being billed.

In Supportive Care’s case, the alleged hospital admission gives that comparison a concrete starting point. We would want to understand what happened to the psychological-service claims when a resident left for the hospital, and who inside the business knew about the move. That is where an employee’s account can give meaning to a billing entry.

One CEO Across the Supportive Care Companies

The same CEO served Supportive Care Holdings and each of the companies named in the settlement. The U.S. Attorney for the District of Connecticut and the Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General announced the resolution on June 13, 2024. It covered alleged conduct from 2019 through 2023.

Beyond Supportive Care Holdings, the announcement names Supportive Care, LLC, Step Up Care, PC LLC and Sunrise Psychological Services, LLC. It also names Supportive Care of Pennsylvania, LLC, Supportive Care Psychology of NJ, PC and Supportive Care Psychology of NY, PC.

The other names are Supportive Behavioral Care of MA, LLC, Step Up Care of Tennessee, LLC, Supportive Care of Virginia, LLC and Supportive Care of Maryland, LLC. The list continues with Supportive Care of New Hampshire, LLC, Supportive Care of South Carolina, LLC, Supportive Care of Michigan, LLC and Supportive Care I of Rhode Island, PC.

For an employee who knows one of those operating names, the connection matters: the settlement announcement covered the group and its CEO together. The allegations concern the psychological-service business’s billing, including fees the government said belonged to the nursing facilities where its patients lived.

The Office of Inspector General investigated the matter, and an Assistant U.S. Attorney handled the case.

The Civil Settlement and Whistleblower Rewards

The federal settlement resolved False Claims Act allegations concerning both billing practices.

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 worked with the residents, delivered the care or saw how the facility fees were billed, tell our whistleblower experts where the claims stopped matching the work. We build the case around the operational knowledge you bring, find behavioral-health fraud whistleblower lawyers who know these payment distinctions and stay beside you through the case.