The federal judge overseeing a complex alleged Medicare fraud case against Life Care Centers of America had a simple question to begin Wednesday's meeting.
"What's this case about?" asked U.S. District Judge Harry S. "Sandy" Mattice.
The whistle-blower lawsuit against the private nursing home company with headquarters in Cleveland, Tenn., involves allegations of a "nationwide scheme" to bilk Medicare by charging for unnecessary services or overcharging for patient services, according to Assistant U.S. Attorney Elizabeth Tonkin.
Wednesday's meeting was to begin sceduling court dates in the already four-year-old investigation. Documents were sealed and hearings closed before the Chattanooga Times Free Press requested access last year.
Tonkin told the judge that she and fellow prosecutors planned to take a sampling of 300 to 500 patient records at 60 to 80 of the company's 225 facilities to obtain a statistical sample that would better simplify the case for trial.
One of Life Care's attorneys, Roger Dickson, disagreed.
Allegations include forcing end-of-life patients to do walking therapy, requiring two hours of various therapies daily for six days a week and coding Medicare patients at the highest possible therapy level upon entry to the facility.
Emails cited in court records show mid- and senior-level Life Care managers pushing nursing home staff and contracted therapists to provide more care even when those people argued it wasn't necessary.
Prosecutors claim to have interviewed more than 150 Life Care employees and others connected to its services.
The company has facilities in 28 states.
The subjective nature of how patients at nursing care facilities are assessed and the individualized decisions on each patient makes it nearly impossible to produce a representative sample.
Dickson said the company had already disclosed about 1 million documents under administrative subpoena. He said there could be as many as 5,000 claims involved in the trial.
"Do we have to try them all? And I think we do," Dickson told Mattice.
Mattice wanted the lawyers to tell, at what point, he would have to decide if the case could continue on the statistical sample plan.
Tonkin said it's likely the judge could decide that after some of the evidence is in and been reviewed, which could be as early as the next scheduling conference set for June 12.
Contact staff writer Todd South at tsouth@timesfree press.com or 423-757-6347. Follow him on Twitter @tsouth CTFP.