SNF Chain Agrees to Corporate Integrity Agreement, $17M Payment to Settle Medicare Fraud Claims
September 21, 2020 | Aging Services Risk Management
A skilled nursing facility (SNF) chain and 27 of its affiliated SNFs have agreed to pay $16.7 million and enter into a corporate integrity agreement (CIA) to resolve allegations that they violated the False Claims Act by submitting false Medicare claims, according to a July 13, 2020, news release from the U.S. Attorney's Office for the Central District of California.
The chain and the SNFs allegedly submitted false claims by seeking Medicare Part A reimbursement for rehabilitation services that were not reasonable or necessary. The chain set preplanned targets for Medicare revenue, regardless of individual patients' therapy needs. However, the only way to achieve these targets was by billing at the "ultra high" therapy level for a large proportion of patients. The alleged conduct occurred over periods...