In the Courts: Therapy Provider Settles False Claims Act Allegations for $125M
January 29, 2016 | Aging Services Risk, Quality, & Safety Guidance
The largest provider of therapy in the United States and its parent company have agreed to pay $125 million to settle claims that they violated the False Claims Act by causing skilled nursing facilities (SNFs) to submit claims to Medicare for services that were not reasonable, necessary, and skilled or that were never provided, reports a January 12, 2016, news release from the U.S. Department of Justice (DOJ).
The therapy provider contracts with more than 1,000 SNFs in 44 states. The government's complaint alleged that the therapy provider set unrealistic financial goals and scheduled therapy to maximize reimbursement without regard to patients' clinical needs. For example, the provider "presumptively" put patients in the highest therapy reimbursement level, increased the amount of therapy reportedly provided during assessment reference periods, scheduled and reported the provision of therapy after patients' therapists recommended discharge from therapy, shifted the number of therapy minutes among types of therapy (e.g., physical, occupational, speech) to maximize reimbursement, provided significantly more therapy at the end of...