Chicago-Area Physical Therapy Center and 4 Nursing Facilities to Pay $9.7M to Resolve False Claims

[TexasTowelie]

Chicago-Area Physical Therapy Center and 4 Nursing Facilities to Pay $9.7 Million to Resolve False Claims Act Allegations


CHICAGO — The U.S. Attorney’s Office in Chicago today announced that a Chicago-area physical therapy center and four nursing facilities have agreed to pay $9.7 million to resolve civil allegations that they violated the False Claims Act by providing unnecessary services to increase Medicare payments.

The settlements and consent judgments resolve allegations that skilled therapy service provider QUALITY THERAPY & CONSULTATION INC. and its owner, FRANCES PARISE, worked with the four skilled nursing facilities — THE CARLTON AT THE LAKE INC., RIDGEVIEW REHAB AND NURSING CENTER, LAKE SHORE HEALTHCARE AND REHABILITATION CENTRE LLC, and BALMORAL HOME INC. — to increase Medicare reimbursements by “upcoding” their patients’ “Resource Utilization Group” scores. A “RUG” score indicates a patient’s care requirements based on the level of physical-, occupational-, and speech-rehabilitation therapy the patient receives, and the complexity of the skilled nursing care the patient requires. The higher the RUG score, the higher the amount paid by Medicare to the nursing facility. The allegations also contend that the providers rendered skilled therapy to patients who did not need it or could not benefit from it, as part of an effort to bill the highest possible amount to Medicare.

The settlements and consent judgments resolve a civil lawsuit filed in U.S. District Court in Chicago by a former employee of Quality Therapy and Consultation under the qui tam, or whistleblower, provisions of the False Claims Act. The Act permits private citizens to bring lawsuits on behalf of the United States for false claims, and to share in any recovery. The United States intervened in the lawsuit prior to the settlements and consent judgments.

The settlements and consent judgments were announced by John R. Lausch, Jr., United States Attorney for the Northern District of Illinois; Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General; and Jeffrey S. Sallet, Special Agent-in-Charge of the Chicago office of the FBI. The government is represented by Assistant U.S. Attorney Sarah J. North.

Read more: https://www.justice.gov/usao-ndil/pr/chicago-area-physical-therapy-center-and-4-nursing-facilities-pay-97-million-resolve