by Ben Vernia | July 18th, 2018
On July 18, the Department of Justice announced that two consulting firms and nine skilled nursing facilities in Florida and Alabama agreed to pay $10 million to settle civil claims, originally brought by three former employees of one of the nursing homes. DOJ’s press release stated:
Southern SNF Management, Inc., Rehab Services in Motion d/b/a Dynamic Rehab and nine affiliated skilled nursing facilities in Florida and Alabama have agreed to resolve allegations that they violated the False Claims Act by submitting or causing the submission of false claims to Medicare for medically unnecessary rehabilitation therapy services, the Department of Justice announced today. Under the agreement, Southern SNF, Dynamic Rehab and the nine skilled nursing facilities will pay the United States a total of $10 million.
“Today’s settlement demonstrates our continuing commitment to ensure that Medicare providers do not place their own financial gain over patients’ clinical needs,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “Such conduct is especially unacceptable when it seeks to take advantage of older Americans, who are some of the most vulnerable members of our community.”
Medicare reimburses skilled nursing facilities based on a patient’s Resource Utilization Group (RUG) level, which is supposed to be determined by the amount of skilled rehabilitation therapy required by the patient. The United States alleged that between October 2009 and December 2013, Southern SNF, Dynamic Rehab and the nine skilled nursing facilities’ corporate policies and practices encouraged the provision of medically unreasonable and unnecessary therapy without regard for patients’ individual clinical needs. The companies’ actions resulted in the submission of false claims based on inflated RUG levels.
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The three whistleblowers will share $2 million (a 20% relators’ share), the government also announced.
