The United States Department of Justice settled a case against a nursing home regarding allegations that the nursing home billed Medicare for services that were neither reasonable, necessary, nor skilled. A nursing home employee could have reported this fraud against the government and earned 15-25% of the government’s recovery.
The nursing home, England Associates, L.P. DBA New London Health Center (New London) allegedly sought to bilk Medicare by manipulating therapy reimbursement levels and billing time. Therapy reimbursement levels fall into different categories, with reimbursements increasing positively corresponding with patient need or severity: High, Very High, and Ultra High levels of therapy. New London allegedly categorized patients as needing Ultra High therapy without considering whether these patients needed 720 minutes of physical, occupational, or speech therapy or not. The allegations continue with New London again disregarding patients’ actual needs and supplying therapy for the minimum number of minutes to reach the threshold for billing at a certain level. Nursing home staff also allegedly increased care during certain intervals to bill for the higher intensity levels (Medicare allows for therapy to be billed in 8-minute increments). The final allegation is that the nursing home “pressure[ed] therapists and patients to complete the planned minutes of therapy regardless of patient need,” including when therapy was contraindicated.
Medicare requires that...
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