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  • Top SNF Therapy Provider Settles DOJ Lawsuit for $125 Million

    The US Department of Justice (DOJ) announced that the nation's largest nursing home therapy provider has agreed to pay $125 million to settle a DOJ lawsuit that alleged the company engaged in a "systematic and broad-ranging scheme" to increase Medicare reimbursements by submitting false claims for rehabilitation therapy.

    RehabCare Group Inc, RehabCare Group East Inc, and parent company Kindred Healthcare will pay out the money in response to allegations that they violated the False Claims Act by "providing unreasonable and unnecessary services to Medicare patients," and that they "led … SNF [skilled nursing facility] customers to submit artificially and improperly inflated bills to Medicare that included those services," according to a DOJ press release. RehabCare contracts with more than 1,000 SNFs in 44 states to provide rehabilitation therapy.

    The alleged violations include:

    • Placing patients in the highest-possible reimbursement levels, regardless of determinations made through patient evaluation
    • "Boosting" the amount of reported therapy during "assessment reference periods" and then providing less therapy to those patients outside of those reference periods
    • Scheduling and reporting the provision of therapy, even after the patients' therapist had recommended discharge
    • Shifting minutes of planned therapy among disciplines "to ensure targeted therapy reimbursement levels were achieved, regardless of the clinical need for therapy"
    • Providing higher amounts of therapy near the end of a therapy measurement period to maximize payment
    • Reporting time spent on initial evaluation as therapy time rather than evaluation time
    • Reporting that skilled therapy had been provided "when in fact the patients were asleep or otherwise unable to undergo or benefit from skilled therapy"
    • Reporting estimated or rounded minutes of therapy rather than actual minutes provided

     

     According to DOJ, the settlement is also linked to 4 other settlements with individual SNFs for their roles in submitting false claims of therapy provided by RehabCare. Those payments range from $3.9 million to $750,000.

    The $125 million RehabCare settlement is the result of a whistleblower lawsuit brought to the DOJ by APTA member Janet Mahoney, PT, DPT, and Shawn Fahey, an occupational therapist. Both worked for RehabCare.

    SNF billing practices began making headlines late last summer, when the Wall Street Journal published a report outlining the findings of its study of the use of "ultrahigh" therapy hours, and resurfaced in October when the Office of the Inspector General of the US Department of Health and Human Services (HHS) issued a report highly critical of SNFs. That report was in turn the subject of a New York Times article on the issue, an article that prompted a letter to the editor from APTA President Sharon L. Dunn, PT, PhD, OCS, published in the Times.

    In the DOJ press release, Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the DOJ's Civil Division, says that the scrutiny will continue.

    "Medicare beneficiaries are entitled to receive care that is dictated by their clinical needs rather than the fiscal interests of health care providers," Mizer said. "All providers, whether contractors or direct billers of taxpayer-funded federal health care programs, will be held accountable when their actions cause false claims for unnecessary services."

    Helping physical therapists and physical therapist assistants understand their obligation to eliminate fraud, abuse, and waste is the central idea behind APTA's online Center for Integrity in Practice—a suite of resources to support care based on patient need and clinical judgment.

    The Good Stuff: Members and the Profession in Local News, January 2016

    "The Good Stuff," is an occasional series that highlights recent, mostly local media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    Laurent Ziaks, PT, DPT, ATC, the "queen of concussions," describes her work with concussion recovery, and how her own injuries inform her approach. (Deseret, Utah, News)

    Darrin Taullie, PT, DPT, offers advice to seniors on becoming more physically active (La Junta, Colorado, Tribune-Democrat)

    "The prosthetic guy came to my hospital room, and he said, 'You can get 120 Percocets a month and watch TV all day, or you can put a leg on and go to work.' I want to put a leg on and go to work." --Plumber Ryan Pater, on his path of rehabilitation after amputation. (Middletown, Ohio, Journal-News)

    Amber Devers, PT, DPT, NCS, explains her clinic's participation in an exoskeleton research program: "We are interested in seeing how the Indego exoskeleton helps people after stroke compared to other devices." (Richmond Times-Dispatch)

    Sandra Terrazas, PT, comments on her clinic's efforts to increase physical fitness among older adults: "Our [physical therapy] training was about restoring function, but it's also about quality of life." (El Paso Plus)

    Brad Cooper, PT, MSPT, MBA, MTC, ATC, CWC, (and author of PT in Motion's "Well To Do" column),"The world's fittest CEO" – Video profile of Cooper and his completion of the "endurance trifecta." (Colorado Business Journal)

    "Physical therapy hurts so good" (Opinion in Fort Wayne, Indiana Journal Gazette)

    Christopher Mulvey, PT, DPT, describes the similarities between learning to ride a hoverboard and regaining balance after an injury, in a story about southwest Florida's "first-ever hoverboard training center." (Fox 4 News, Cape Coral, Florida)

    Adele Levine, PT, DPT, OCS, writes about how combat amputees and their therapists "find roads to happiness." (New York Times)

    "It's difficult being injured, but you learn some different techniques and a lot of little details when you're in physical therapy every day. Things like your hip and back alignment that you might not think about very much, but there are a lot of things to do (to prevent injuries) in those areas." --Julia Krass, the youngest athlete selected for the US slopestyle ski team, on her road to recovery. (West Lebanon, New Hampshire Valley News, free login required)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.