July 18, 2018

Two consulting companies and nine nursing homes will pay $10M to resolve allegations that they submitted claims for medically unnecessary rehabilitation services to Medicare. Medicare reimburses nursing homes based on Resource Utilization Group (RUG) levels, which are supposed to determine the amount of skilled therapy required by a patient. The government alleges that the nursing homes, as advised by the consulting companies, encouraged medically unreasonable and unnecessary therapy to inflate RUG levels. The case was filed by three whistleblower, who will receive a total award of $2M. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, SNF, Whistleblower Case, Whistleblower Rewards,