Wednesday, January 13, 2016 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.