A Michigan-based rehabilitation provider agreed to pay $4 million to settle allegations that it caused three skilled-nursing facilities to submit false Medicare claims.
Encore Rehabilitation Services works with 600 healthcare facilities in 30 states to provide patients with rehab services. According to the U.S. Department of Justice, Encore provided unnecessary, unreasonable or unskilled rehab services at three Michigan SNFs, or recorded that it provided individual therapy sessions when it conducted in concurrent or group sessions.
The alleged conduct took place between 2010 and 2018.
"Billing federal healthcare programs for medically unnecessary rehabilitation services not only undermines the viability of those programs, it exploits our most vulnerable citizens," said U.S. Attorney Matthew Schneider for the Eastern District of Michigan, in a statement. "We are committed to working with our federal partners to protect both vulnerable Michiganders and these helpful healthcare programs."
The CMS last year scrapped a payment model that encouraged potentially unnecessary therapy services.
As part of the settlement, Encore also agreed to a five-year corporate integrity agreement with HHS OIG and will need to implement an internal review process to keep track of its compliance.
The False Claims Act allegations initially came to light in whistleblower lawsuits by four former Encore employees. The Justice Department said it had not yet determined their awards from the settlement.
Encore did not admit liability as part of the settlement.