“Longwood’s business plan called for substantial revenue from Medicare, and it pressured therapists to provide additional, unnecessary services when targets were not met,” said U.S. Attorney Nick Hanna for the Central District of California. “This case demonstrates the power of whistleblowers to shine a light on improper business practices and obtain significant recoveries on behalf of United States taxpayers.”
The settlement resolves allegations that Longwood submitted false claims for rehabilitation therapy by engaging in a systematic effort to increase Medicare billings. Medicare reimburses skilled nursing facilities at a daily rate that reflects the skilled therapy and nursing needs of qualifying patients. The greater the patient’s needs, the higher the level of Medicare reimbursement. The highest level of Medicare reimbursement for skilled nursing facilities is for “Ultra High” therapy patients, who require a minimum of 720 minutes of skilled therapy from two therapy disciplines (e.g., physical, occupational, or speech therapy), one of which has to be provided five days a week.
This is probably a slap on the wrist.
Assume a monthly rent of $4,000/month or $48,000/year, the $16,700,000 represents on 348 rooms, round to 350 rooms.
I will wager this firm has a whole bunch more than 350 rooms.
It’s certainly known as an area ripe for fraud - take an elderly or otherwise vulnerable patient, charge them for services they don’t need or receive. Most of them would have no idea.
“Granny, did you need PT 5 days a week for 2 years?!”
The other frequent scam being medical supplies/DME.