Consulting Companies and Nine Affiliated Skilled Nursing Facilities to Pay $10 Million to Resolve False Claims Act Allegations Relating to Medically Unnecessary Rehabilitation Therapy Services
Whistleblowers Awarded $2 Million
Seattle Whistleblower Attorneys report that Southern SNF Management, Inc., Rehab Services in Motion d/b/a Dynamic Rehab and nine affiliated skilled nursing facilities in Florida and Alabama have agreed to resolve allegations that they violated the False Claims Act by submitting or causing the submission of false claims to Medicare for medically unnecessary rehabilitation therapy services. Under the agreement, Southern SNF, Dynamic Rehab and the nine skilled nursing facilities will pay the United States a total of $10 million.
Medicare reimburses skilled nursing facilities based on a patient’s Resource Utilization Group (RUG) level, which is supposed to be determined by the amount of skilled rehabilitation therapy required by the patient. The United States alleged that between October 2009 and December 2013, Southern SNF, Dynamic Rehab and the nine skilled nursing facilities’ corporate policies and practices encouraged the provision of medically unreasonable and unnecessary therapy without regard for patients’ individual clinical needs. The companies’ actions resulted in the submission of false claims based on inflated RUG levels.
The allegations resolved by this settlement arose from a whistleblower lawsuit filed under the False Claims Act by La-Wanda Davis, Tramecier Donald, and Megan Dinkins, former employees of one of the skilled nursing facilities. Under the False Claims Act, private citizens can sue on behalf of the government for false claims and share in any recovery. The whistleblowers will receive $2 million of the recovered funds.
The case is captioned United States ex rel. Davis, et al. v. Southern SNF Management, Inc., et al., Case No.13-000384-WSM (S.D. Ala.). The claims resolved by the settlement are allegations only; there has been no determination of liability.
Source: Dept. of Justice.
Medicare reimburses skilled nursing facilities based on a patient’s Resource Utilization Group (RUG) level, which is supposed to be determined by the amount of skilled rehabilitation therapy required by the patient. The United States alleged that between October 2009 and December 2013, Southern SNF, Dynamic Rehab and the nine skilled nursing facilities’ corporate policies and practices encouraged the provision of medically unreasonable and unnecessary therapy without regard for patients’ individual clinical needs. The companies’ actions resulted in the submission of false claims based on inflated RUG levels.
The allegations resolved by this settlement arose from a whistleblower lawsuit filed under the False Claims Act by La-Wanda Davis, Tramecier Donald, and Megan Dinkins, former employees of one of the skilled nursing facilities. Under the False Claims Act, private citizens can sue on behalf of the government for false claims and share in any recovery. The whistleblowers will receive $2 million of the recovered funds.
The case is captioned United States ex rel. Davis, et al. v. Southern SNF Management, Inc., et al., Case No.13-000384-WSM (S.D. Ala.). The claims resolved by the settlement are allegations only; there has been no determination of liability.
Source: Dept. of Justice.