{"id":19252,"date":"2016-01-12T15:35:44","date_gmt":"2016-01-12T23:35:44","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=19252"},"modified":"2016-01-12T15:35:44","modified_gmt":"2016-01-12T23:35:44","slug":"nations-largest-home-therapy-provider-to-pay-125-million-for-allegedly-submitting-false-claims","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=19252","title":{"rendered":"Nation’s Largest Home Therapy Provider to Pay $125 Million for Submitting False Claims"},"content":{"rendered":"

Massachusetts<\/strong><\/span><\/p>\n

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\"fraud-medicare-card-cube\"The nations largest nursing home therapy provider, Kindred\/Rehabcare<\/strong> will pay $125 million to settle allegations of filing false claims to Medicare for rehabilitation, according to authorities.<\/span><\/p>\n

Four nursing homes using Kindred\/Rehabcare will pay an additional $8.2 million to the federal government, officials said.<\/span><\/p>\n

\u201cHealth providers seeking to increase Medicare profits, rather than providing suitable, high-quality care, will be investigated and prosecuted,\u201d said Inspector General Daniel R. Levinson for the U.S. Department of Health and Human Services.<\/strong>\u00a0 \u201cUnder our robust compliance agreement, an outside review organization will scrutinize a random sample of medical records annually to assess the medical necessity and reasonableness of therapy services provided by RehabCare.\u201d<\/span><\/p>\n

This case was brought to light after a whistleblowers’ lawsuit was filed by RehabCare employees\u00a0Janet Halpin<\/strong>, a physical therapist and former rehabilitation manager for RehabCare and Shawn Fahey,<\/strong> an occupational therapist,<\/span><\/p>\n

The whistleblowers will receive nearly $24 million as their share of the recovery from RehabCare.<\/span><\/p>\n

Whistleblower law allows\u00a0private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery.\u00a0 <\/span><\/p>\n

The government may intervene and file its own complaint in such a lawsuit, as it has done in this case, according to officials.<\/span><\/p>\n

RehabCare Group Inc. and RehabCare Group East Inc. were purchased by the Louisville,<\/strong> Kentucky-based Kindred Healthcare Inc<\/strong>. in 2011 and they now operate under the name RehabCare as a division of Kindred.\u00a0 <\/span><\/p>\n

RehabCare is the largest provider of therapy in the nation, contracting with more than 1,000 skilled nursing facilities in 44 states to provide rehabilitation therapy to their patients.<\/span><\/p>\n

The government\u2019s complaint alleged that RehabCare\u2019s practices, including setting unrealistic financial goals and scheduling therapy to achieve the highest reimbursement level regardless of the clinical needs of its patients, resulted in Rehabcare providing unreasonable and unnecessary services to Medicare patients.<\/span><\/p>\n

This lead\u00a0its skilled nursing facilities customers to submit artificially and improperly inflated bills to Medicare that included those services, officials said.<\/span><\/p>\n

Specifically, the government\u2019s complaint alleged that RehabCare\u2019s schemes included the following:<\/strong><\/span><\/p>\n

Presumptively placing patients in the highest therapy reimbursement level, rather than relying on individualized evaluations to determine the level of care most suitable for each patient\u2019s clinical needs<\/span><\/p>\n

During the period prior to Oct. 1, 2011, boosting the amount of reported therapy during \u201cassessment reference periods,\u201d thereby causing and enabling skilled nursing facilities to bill for the care of their Medicare patients at the highest therapy reimbursement level.<\/span><\/p>\n

This was done while\u00a0providing materially less therapy to those same patients outside the assessment reference periods, when the SNFs were not required to report to Medicare the amount of therapy RehabCare was providing to their patients (a practice known as \u201cramping\u201d)<\/span><\/p>\n

Scheduling and reporting the provision of therapy to patients even after the patients\u2019 treating therapists had recommended that they be discharged from therapy<\/span><\/p>\n

Arbitrarily shifting the number of minutes of planned therapy among different therapy disciplines such as physical, occupational and speech therapy to ensure targeted therapy reimbursement levels were achieved, regardless of the clinical need for the therapy<\/span><\/p>\n

Especially after Oct. 1, 2011 and continuing through Sept. 30, 2013, providing significantly higher amounts of therapy at the very end of a therapy measurement period not due to medical necessity but rather to reach the minimum time threshold for the highest therapy reimbursement level, to enable skilled nursing facilities to bill for the care of their Medicare patients accordingly, even though the patients were receiving materially less therapy on preceding days,<\/span><\/p>\n

Inflating initial reimbursement levels by reporting time spent on initial evaluations as therapy time rather than evaluation time.<\/span><\/p>\n

Reporting that skilled therapy had been provided to patients when in fact the patients were asleep or otherwise unable to undergo or benefit from skilled therapy.<\/span><\/p>\n

Reporting estimated or rounded minutes instead of reporting the actual minutes of therapy provided.<\/span><\/p>\n

In addition to RehabCare, the Department of Justice<\/strong> also announced settlements today with four skilled nursing facilities\u00a0for their role in submitting claims to Medicare that were false because they were based in part on therapy provided by RehabCare that was not reasonable, necessary and skilled, or that did not occur.<\/span><\/p>\n

These settlements include the following facilities:<\/strong><\/span><\/p>\n