CHICAGO (LN) — Three affiliated Illinois skilled nursing facilities agreed to pay $0.30 million to resolve False Claims Act allegations that they billed Medicare for physical therapy, occupational therapy, and speech pathology services that were longer than medically necessary, the Justice Department announced Thursday.
The settling entities — Symphony Jackson Square LLC, doing business as Symphony of Chicago West; Symphony Park South LLC, doing business as Symphony of Morgan Park; and Symphony Midway LLC — are accused of inflating their Medicare reimbursements between Jan. 1, 2014, and Sept. 30, 2019, by providing therapy services without regard for patients' individual medical needs.
The alleged scheme exploited Medicare's pre-2019 resource utilization group reimbursement structure, under which skilled nursing facilities were paid more the longer a patient received therapy each week. The government alleged the facilities gamed that system by running up therapy hours to reach higher reimbursement tiers rather than tailoring care to what patients actually required.
The settlement amount reflects the facilities' ability to pay, the Justice Department said.
"We expect nursing facilities to provide their patients, which include some of our most vulnerable citizens, reasonable and appropriate amounts of skilled rehabilitation therapy services," said Assistant Attorney General Brett A. Shumate of the Civil Division. "The Department is committed to holding accountable skilled nursing facilities that provide services based on their financial interests rather than the clinical needs of their patients."
U.S. Attorney Andrew S. Boutros for the Northern District of Illinois said his office would "remain vigilant in our efforts to deter those who seek to exploit critically important federal health care programs that are intended to help people in need — not cheats who seek to abuse and misuse our nation's generosity."
The case originated as a whistleblower lawsuit filed by Integra Med Analytics LLC under the False Claims Act's qui tam provisions, which allow private parties to sue on the government's behalf and collect a share of any recovery. The case is captioned United States ex rel. Integra Med Analytics LLC v. Symphony Healthcare LLC et al., No. 20-CV-0348, in the Northern District of Illinois.
Integra Med Analytics will receive $45,000 of the recovered funds.
The Justice Department stressed that the claims resolved by the settlement are allegations only and that no determination of liability has been made.