Federal Government Recoups $2.6 Billion From SNFs for Fraud Federal officials recovered $226.4 million in fiscal year 2017 from settlements with skilled nursing facilities to resolve allegations of fraud against Medicare and other federal health programs. That total was a fraction of the $2.6 billion recovered during the year ending Sept. 30, 2017, by the federal Health Care Fraud ... News in Brief
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News in Brief  |   July 01, 2018
Federal Government Recoups $2.6 Billion From SNFs for Fraud
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News in Brief
News in Brief   |   July 01, 2018
Federal Government Recoups $2.6 Billion From SNFs for Fraud
The ASHA Leader, July 2018, Vol. 23, 9. doi:10.1044/leader.NIB3.23072018.9
The ASHA Leader, July 2018, Vol. 23, 9. doi:10.1044/leader.NIB3.23072018.9
Federal officials recovered $226.4 million in fiscal year 2017 from settlements with skilled nursing facilities to resolve allegations of fraud against Medicare and other federal health programs.
That total was a fraction of the $2.6 billion recovered during the year ending Sept. 30, 2017, by the federal Health Care Fraud Prevention and Enforcement Action Team. This effort of the U.S. Departments of Justice and Health and Human Services identifies, prevents and prosecutes health care fraud.
The settlements with the skilled nursing facilities (SNFs) resolve allegations related to billing for medically unnecessary services.
  • Life Care Centers of America—$145 million to settle civil allegations that it caused skilled nursing facilities (SNFs) to submit false claims to Medicare and TRICARE for rehabilitation therapy services that were not reasonable, necessary or skilled in an effort to increase its billings.

  • Genesis HealthCare—$53.6 million to settle civil allegations that its companies and facilities billed for more therapy minutes than the patients actually received, provided therapy longer than medically necessary, and provided therapy more often than necessary.

  • Reliant Care Group—$8.3 million to resolve claims for providing unnecessary physical, speech and occupational therapy to nursing home residents who had a relatively high level of independence and who were in a SNF primarily because of psychiatric conditions.

  • Foundations Health Solutions Inc., Olympia Therapy Inc., and Tridia Hospice Care Inc.—$19.5 million to settle allegations they submitted false claims for medically unnecessary rehabilitation therapy and hospice services to Medicare.

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July 2018
Volume 23, Issue 7