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Sanders House Pays Over $ 819,000 To Resolve Fraudulent Claims Liability resulting From Rehabilitation Therapy Claims – Mainline Media News

Lower Melion — Winwood’s Sanders House resolves allegations that skilled nursing facilities provided residents with medically unnecessary rehabilitation therapies to maximize income, without prioritizing clinical needs. I was ordered to pay $ 819,640 to do so.

The settlement resolves whistleblower complaints filed in federal court in the Eastern District of Pennsylvania under the Quitham clause of the False Claims Act. These provisions allow civilians to file civil suits and share recovery on behalf of the United States.

Whistleblower, a physiotherapist assistant who provided physiotherapy services at Sanders House through employment with contracted treatment providers, generally claimed that Sanders House overcharged federal medical programs such as Medicare for treatment services. did.

He claimed that Sanders House overcharged federal medical programs such as Medicare for treatment services and charged for services that were not provided.

Other allegations were that they claimed for unreasonable, unnecessary, and sometimes harmful treatments, allowing treatment providers to manipulate clinical services to maximize their claims. ..

“Focusing on interests rather than the needs of individual patients creates the potential to undermine public confidence and harm some of our most vulnerable people,” said Romero, a lawyer in the United States. Says. “It also shifts taxpayer funds from the key services of law-abiding treatment providers. We thank whistleblowers for helping the government recognize these claims. We would also like to thank Saunders House for their full cooperation in the government’s investigation. Cooperation was taken into account in determining the appropriate solution to these allegations. “

During the relevant period, Medicare Apartment A paid on a pro-rated basis for services provided to skilled nursing facility beneficiaries, in part based on the Resource Utilization Group (RUG) to which the beneficiaries are assigned. ..

Each individual RUG was intended to reflect the expected costs associated with providing nursing and rehabilitation services to beneficiaries with similar characteristics or resource needs. The highest redemption level was super high or RU.

The resolution is based on the allegation that Saunders House caused false claims of ultra-high RUG treatment levels, despite evidence that the RU levels of treatment were not reasonable or necessary for each patient.

“Protecting the integrity of our Medicare program is paramount,” said Maureen R. Dixon, Special Agent for Inspection, US Department of Health and Human Services. “Patients need to rely on the decisions made by their healthcare providers, knowing that those decisions are made to improve their condition rather than increasing the individual benefits of their healthcare provider. HHS-OIG will continue to work with US law firms to investigate allegations of fraud. “

US federal prosecutors Landon Y. Jones III and Elizabeth L. Coin handle the case in the eastern part of Pennsylvania with the help of auditor Dawn Wiggins, and Albert, a lawyer in the Civil Fraud Division of the Department of Justice. I worked with Mayer. ..

Sanders House Pays Over $ 819,000 To Resolve Fraudulent Claims Liability resulting From Rehabilitation Therapy Claims – Mainline Media News

Source link Sanders House Pays Over $ 819,000 To Resolve Fraudulent Claims Liability resulting From Rehabilitation Therapy Claims – Mainline Media News

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