SNF Operator Agrees to Pay $9.5M to Settle FCA Allegations of Unnecessary and Unskilled Therapy

March 23, 2020 | Aging Services Risk, Quality, & Safety Guidance

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A skilled nursing facility (SNF) operator with 74 facilities has agreed to pay $9.5 million to settle claims that it knowingly submitted false claims for rehabilitation therapy to Medicare, in violation of the False Claims Act (FCA), according to a February 28, 2020, news release from the U.S. Department of Justice. The government alleged that the company provided unskilled, unnecessary, and unreasonable therapy to many Medicare beneficiaries. The company also purportedly forged preadmission evaluations to establish the need for skilled nursing and submitted them to the state Medicaid program.

According to the allegations, for a period of six years, the company's corporate policies and practices were aimed at maximizing the number of beneficiaries billed for at the highest level of Medicare reimbursement for therapy (Ultra High) regardless of each patient's clinical needs. The company submitted Ultra High therapy claims despite evidence, in various cases, that the frequency and duration or intensity of physical or...

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