Home Health & Hospice Week

Home care providers aren’t the only ones getting major scrutiny for therapy. The De-partment of Justice is cracking down on Medicare claims for rehabilitation therapy services in skilled nursing facilities.

The Ensign Group Inc., a skilled nursing provider based in California that also owns home health and hospice business lines, is paying out $48 million for allegedly submitting false Medicare claims for medically unnecessary rehab therapy services, the DOJ recently announced. From 1999 through 2011, six Ensign facilities "allegedly submitted false claims to the government for physical, occupational and speech therapy services provided to Medicare beneficiaries that were not medically necessary," the DOJ states.

The settlement agreement further alleged that the Ensign facilities kept patients longer than medically necessary, billed for inflated amounts of therapy not provided, and "improperly incentivized therapists and others to increase the amount of therapy provided to patients to meet planned targets for Medicare revenue," the DOJ says. "These targets were set without regard to patients’ individual therapy needs and could only be achieved by billing at the highest reimbursement levels."

In addition to shelling out nearly $50 million, each of Ensign’s six SNFs have entered Cor-porate Integrity Agreements (CIAs) with the OIG. The settlement is one of the largest Medicare fraud cases against a nursing home chain in U.S. history, according to the U.S. Attorney for the Central District of California Andre Birotte, Jr.

Last spring, Ensign noted that it had seven hospice companies and seven home health businesses in addition to its skilled nursing, rehab, assisted living and urgent care facilities. "Ensign is actively seeking additional opportunities to acquire both well-performing and struggling home health and hospice operations across the United States," the company said at the time.

With this high-dollar-amount SNF therapy settlement as a precedent, the feds could turn to home care therapy for a major payout next, industry observers fear.