The largest nursing home therapy provider in the U.S. – with 43 locations in North Carolina – has agreed to pay $125 million after a Department of Justice investigation revealed evidence of false claims to Medicare. Another $8 million will be paid by operators of individual facilities for similar allegations.
According to the DOJ, these facilities routinely performed therapy that wasn’t needed or charged for therapy they never gave.
Kindred Healthcare Inc. and its subsidiary, RehabCare Group Inc., contract with more than 1,000 skilled nursing facilities in 44 states to provide rehabilitation therapy to patients, many of whom are elderly.
This was a qui tam claim, brought about under the False Claims Act, and the government was alerted to the alleged fraud by two whistleblowers, an occupational therapist and a physical therapist. Those two will be eligible to receive nearly $24 million in reimbursements. The DOJ had previously reached several other settlements for similar conduct by other skilled nursing care facilities totaling $435 million.
So how does all of this relate to nursing home abuse and neglect in North Carolina? When these kinds of facilities provide therapy that isn’t needed, it can put undue stress on a patient, both physically and emotionally. One of the primary allegations is that therapy providers were instructed to base their patient care plans not on the individual needs of the patient, but rather on what would result in the greatest reimbursement to the facilities.
Still, we use the word “alleged” because this was one of those settlements in which the accused facilities did not have to concede they did anything wrong.
Among the other allegations made in the government’s complaint:
- The facilities automatically put patients at the highest therapy reimbursement level, as opposed to relying on personal evaluations to determine the level and amount of care that would meet each patient’s medical needs;
- Providing significantly less services to patients outside the “assessment reference periods,” when they weren’t required to report therapy levels to the federal government;
- Arbitrarily switching up the number of minutes of planned services for each type of therapy (i.e., speech therapy, occupational therapy, physical therapy) to make sure the facility got as much reimbursement as it could, rather than basing the allotted time on the amount of specific therapy the patient actually needed;
- Bolstering the amount facilities received by counting evaluations as therapy sessions;
- Reporting to the government that therapy had been provided to patients when in fact, those patients were either asleep, unable to attend therapy or it wasn’t possible for them to benefit from it;
- Reporting to the government the amount of time spent in therapy sessions in estimations or in rounded minutes.
All of this has the potential to cause harm to patients. A 2015 report by The New Yorker detailed studies that have shown between 25 and 42 percent of Medicare patients receive at least one of 26 useless tests and treatment. These figures could be significantly higher for elderly nursing home patients, who are more vulnerable and less assertive in the care they receive.
Medicare rules were changed in 1998 to reimburse nursing homes for therapy care based on the level of care provided – from “low” to “ultra high.” The latter category requires 72 hours a week of therapy. In 2002, only 7 percent of nursing hare patients received “ultra high” levels of therapy. By 2013, that figure had skyrocketed to 54 percent.
Contact the Carolina injury lawyers at the Lee Law Offices by calling 800-887-1965.
Nation’s Largest Nursing Home Therapy Provider, Kindred/Rehabcare, to Pay $125M to Resolve False Claims Act Allegations, Jan. 12, 2016, Press Release, Department of Justice
More Blog Entries:
Easterling v. Kendall – Medical Malpractice for Failure to Diagnose, Feb. 2, 2016, Charlotte Nursing Home Abuse Lawyer Blog