Rosseau Management Inc. will pay $300,000 to resolve a Medicare billing fraud lawsuit accusing the assisted living facilities owner of letting subcontractor RehabCare Group East. Inc. turn in fraudulent Medicare claims. The latter provided rehabilitation therapy at three facilities.
According to the Department of Justice’s U.S. Attorney’s Office in the District of Massachusetts, previous to October 2011, Rosseau did not take the necessary steps to stop RehabCare from providing high levels of therapy that were unreasonable or unnecessary during “assessment reference periods.” This caused the assisted living facilities to bill for care for their Medicare patients at the highest levels of reimbursement. During other times when assessment wasn’t a factor, RehabCare gave these same patients less therapy.
The government said that even after October 2011, Rosseau did not stop RehabCare’s other practices that inflated Medicare reimbursement including:
- Placing patients in the highest reimbursement category (unless it was clear that they couldn’t handle that much therapy), as opposed to utilizing individualized evaluations to assess the care level that each patient needed.
- Planning the for the minimum number of therapy minutes so as to bill at the highest reimbursement level.
- Moving around the number of minutes of planned therapy across therapy disciplines to make sure reimbursement goals were achieved
- Reporting the time spent on initial evaluations as therapy time.
- Reporting unskilled palliative care as therapy time.
According to FBI Special Agent Vincent B. Lisi of the Boston Field Division, the defendants made choices on the grounds of profitability rather than patient care. Meantime, U.S. Attorney Carmen M. Ortiz vows continue making sure that the care provided at nursing facilities is based on patient needs rather than the financial interests of the companies providing that care.
In Massachusetts, our Boston Medicare billing fraud lawyers work with whistleblowers seeking to file claims against entities and others that have sought to bilk the government over inflated or false billings. Depending on the specifics of the case, a Qui Tam case could make a claimant eligible to receive up to 30% of what is recovered from the Medicare fraud lawsuit.
Massachusetts Medicare billing fraud can include:
- Up-coding, which may involve assigning the wrong billing code to get back more money.
- Billing for goods and services that were never provided.
- Double-billing for medical services or equipment.
- Unbundling, which involves turning in bills piecemeal to maximize reimbursement even though Medicaid and Medicare guidelines ask that certain procedures and tests be billed together to reduce costs.
- Medical equipment fraud.
The Medicare system provides healthcare services to patients in the 65 and older age group. Medicare billing fraud takes money that should be spent on this patient care and puts the funds in the pockets of wrongdoers.
In Boston, if you know of or suspect that Medicare billing fraud is taking place, contact our Massachusetts Medicare fraud whistleblower lawyers today.
Maine nursing home operator to pay $300,000 to resolve allegations concerning claims for rehabilitation therapy, Justice.gov, April 30, 2015
Report Fraud and Abuse, Medicare.gov
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