The largest nursing home rehabilitation therapy provider in the nation has agreed to a $125 million settlement after federal prosecutors accused the firm of submitting phony Medicare claims.
RehabCare, a subsidiary of Kindred Healthcare Inc., Kentucky-based company, and operators of four facilities, allegedly submitted claims for Medicare service bills that were either not reasonable, not necessary or that simply never occurred.
Why does this matter to patients in nursing homes? First, this is far from an isolated incident. Secondly, when a nursing home or other care facility is more interested in stacking its dollars than in making sure its patients get the right level of care based on their individual needs, patients are at risk for illness, injury and even death.
What our nursing home abuse lawyers have seen in a lot of cases are care facilities that are more concerned about how the procedures, services, equipment and medication are coded and billed rather than whether they actually benefit the patient. In some cases, patients don’t get the care they need. In other instances, they receive care for which they have no need – which can do much more harm than good.
This is just one of the few instances where we’ve seen the a facility held to account for this. On top of the $125 million to be paid by the nursing home chain, the facility operators will pay an additional $8 million for their role.
According to the U.S. Department of Justice, the therapy that was reportedly provided was given to patients who were either asleep or who weren’t able to benefit from it. Other allegations include:
- Placing patients presumptively at the highest therapy reimbursement level, as opposed to using individual evaluations to determine the level of care best suited to the patient’s needs.
- Scheduling patients for ongoing therapy, even when their treating therapists had recommended they be discharged from care.
- Arbitrarily shifting the number of minutes of planned therapy among different therapy disciplines to ensure they could maximize the amount they would be paid for that therapy – regardless of whether the patient actually needed that amount of therapy.
- Increasing the amount of therapy patients received at the end of the month in order to hit target reimbursement rates, regardless of whether the patient actually needed more therapy.
- Reporting therapy in terms of estimates or rounded minutes, as opposed to reporting the actual number of minutes for which therapy was provided.
The case was brought to the government’s attention via a whistleblower. A physical therapist and former rehabilitation manager for the company, as well as an occupational therapist, sued these private entities on behalf of the federal government. There is a provision of the False Claims Act that allows for qui tam action. The whistleblowers in this case will receive nearly $24 million as a result of their efforts in this action.
The DOJ says it will continue to make health care fraud a priority, especially in the elder care realm as our population ages. Elderly patients may be less aware of when they are being taken advantage of in these situations.
If a patient suffers harm due to failing to receive necessary treatment or receiving treatment that isn’t warranted, family members should discuss their legal options with an experienced injury lawyer.
Call Freeman Injury Law — 1-800-561-7777 for a free appointment to discuss your rights. Now serving Orlando, West Palm Beach, Port St. Lucie and Fort Lauderdale.
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Nursing Home Lawsuit After Elderly Man Wanders, Dies in Dumpster, Feb. 2, 2016, Palm Beach Nursing Home Abuse Lawyer Blog