A Maryland-based, not-for-profit skilled nursing corporation, known as Episcopal Ministries to the Aging, Inc. (EMA), has agreed to pay $1.3 million to the federal government to settle allegations it defrauded Medicare by making false claims for reimbursement on behalf of patients within several of its facilities. EMA, a nursing home management organization, is responsible for the oversight and management of several nursing homes and rehabilitation centers. Its liability in the matter is tied to its role in the oversight of daily operations and financial management of the centers; however, it has not admitted any wrongdoing in conjunction with the settlement.
Details of Case Against EMA, Inc.
According to the allegations as outlined by the Department of Justice, EMA is alleged to have submitted several false claims for reimbursement to Medicare on behalf of patients receiving rehabilitation services at William Hill Manor, a facility located on Maryland’s Eastern Shore area. More specifically, EMA contracted with a rehabilitation services company known as RehabCare, Inc., to provide rehab to patients at William Hill Manor. Beginning in 2010, RehabCare, Inc. is alleged to have provided “unreasonable or unnecessary therapy” to patients in order to increase Medicare reimbursements – and EMA was aware of the practice and did nothing to curtail the fraud.
Details of the settlement further reveal that EMA was aware of other fraudulent activities by RehabCare, and did not put a stop to some potentially-dangerous rehabilitation practices. For instance, instead of fully evaluating a patient to determine his or her most appropriate course of rehabilitation treatment, RehabCare would consistently place the patient in the highest level of rehabilitation services, regardless of whether or not the patient needed, or could handle, such rigorous rehabilitation work. Only upon a showing that a particular patient could not tolerate that amount of therapy would RehabCare reduce the treatment plan. This practice runs afoul of Medicare’s clear-cut guidelines requiring that facilities only provide an amount of care congruent with the patient’s needs.
Rehabilitation services are generally reimbursable based on the number of minutes the patient spends on each therapeutic activity. The allegations against EMA, Inc., as pertaining to its relationship with RehabCare, reveal that the latter would shift minutes around between therapy disciplines in order to maximize the reimbursement amount for each activity. The company also reportedly rounded or estimated minutes instead of reporting actual numbers.
Government’s Comments on the EMA, Inc. Settlement
U.S. Attorney Carmen M. Ortiz commented on the matter, stating:
“Patients in our nation’s nursing homes should not be left to wonder whether the therapy they receive is based on their own clinical needs, or is instead tied to the financial targets of the companies providing their care….This settlement makes clear that, when a skilled nursing facility contracts with an outside rehabilitation therapy provider, the facility remains responsible for ensuring that its patients are receiving, and Medicare is paying for, reasonable and necessary care.”
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