Interface Rehab to Pay $ 2 Million to Resolve Claims It Caused Medicare Submissions for Unnecessary or Unreasonable Services | USAO-CDCA

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LOS ANGELES Interface Rehab (Interface), headquartered and operating in Orange County, has agreed to pay $ 2 million to resolve allegations that it violated the False Claims Act by prompting the submission of claims to Medicare for rehabilitative therapy services that were not reasonable or necessary.

Settlement resolves allegations that from January 1, 2006 to October 10, 2014, the Placentia-based interface knowingly submitted or caused the submission of false claims for ultra-high rehabilitation levels that were medically unreasonable and unnecessary to Medicare residents Part A at 11 years old. Qualified nursing facilities. These facilities include the Colonial Care Center, Covina Rehabilitation Center, Crenshaw Nursing Home, Green Acres Lodge, Imperial Care Center, Laurel Convalescent Hospital, Live Oak Rehabilitation Center, Longwood Manor Convalescent Hospital, Monterey Care Center, the San Gabriel Convalescent Center and the Whittier Pacific Care. Center.

In July 2020, the Department of Justice announced that Longwood Management Corporation and 27 affiliated skilled nursing institutions agreed to pay the United States $ 16.7 million to resolve allegations that they violated the False Claims Act. by submitting bogus claims to Medicare for rehabilitative therapy services that were unreasonable or necessary. The regulations announced today resolve Interfaces’ role in this alleged conduct.

During the relevant period, Medicare reimbursed qualified nursing facilities at a per diem rate reflecting the qualified nursing and care needs of eligible patients. The greater the patient’s needs, the higher the Medicare reimbursement level. The highest Medicare reimbursement level for skilled nursing facilities was for ultra-high therapy patients, who required a minimum of 720 minutes of skilled therapy in two therapeutic disciplines (for example, physiotherapy, occupational therapy, or speech therapy) , one of which was to be provided five days a week.

The United States maintains that Interface pressured therapists to increase the amount of therapy provided to patients in order to meet pre-established Medicare revenue targets. These purported goals could only be achieved by billing a high percentage of patients at the Ultra High level without considering the individualized needs of the patients.

Claims that patients required ultra-high levels of care appear to be driven solely by the desire to send ultra-high bills to Medicare, said Acting U.S. Attorney Tracy L. Wilkison for the Central District of California . This case is further evidence that the government will vigorously prosecute those who attempt to cheat the taxpayer-funded system that pays for medical care for millions of Americans, sometimes with the help of whistleblowers who shed light on the fraud.

These regulations reflect our ongoing efforts to protect patients and taxpayers by ensuring that the care provided to recipients of government-funded health care programs is driven by clinical need, not the financial interests of providers, a said Acting Assistant Attorney General Brian M. Boynton for the department. of the Civil Division of Judges. Rehabilitation therapy companies provide important services to our vulnerable elderly population, but they will be held to account if they provide therapy services based on maximizing revenue rather than the best interests of their patients.

Our agency will continue to aggressively investigate healthcare providers who attempt to increase their profits by falsely billing federal healthcare programs for medically unnecessary services, said Special Agent in Charge Timothy B. DeFrancesca of the US Department of Health and Human Services Office of the Inspector General (HHS-OIG). We will not tolerate such fraud schemes, which undermine medical decision making and public confidence in the healthcare profession.

Multi-million dollar settlement agreement signifies significant conclusion to government investigation into Interface Rehabs’ questionable business practices that have tainted the integrity of federal health programs, including the Department of Defense’s TRICARE program , unnecessarily inflating costs, said Paul K. Sternal, deputy director of the Defense Criminal Investigations Service (DCIS). DCIS is committed to working with its law enforcement partners to protect the health interests of our military personnel, their families, and U.S. taxpayers.

This civil settlement includes the resolution of claims filed under the qui tam or whistleblower provisions of the False Claims Act by Keith Pennetti, former director of rehabilitation at Interface. Under these provisions, a private party can sue on behalf of the United States and receive a portion of any recovery. Mr. Pennetti, will receive $ 360,000 of the proceeds of the settlement. The qui tam case is captioned United States ex rel. Pennetti v. Interface Rehab, et al., No. CV-14-4133 (CD Cal.).

The resolution obtained in this case is the result of a coordinated effort between the Civil Divisions Commercial Litigation Branch, the Fraud Section and the US Attorneys Office for the Central District of California with the assistance of the US Department of Health and Human Services Office. of Inspector General. and the Defense Criminal Investigation Service.

The investigation and resolution of this case illustrates the government’s focus on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Advice and complaints from all sources regarding potential fraud, waste, abuse and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).

The case was investigated by Deputy United States Attorney John E. Lee of the Civil Fraud Section of the Civil Divisions and Department of Justice Trial Prosecutor Amy Likoff.

The claims resolved by the settlement are only allegations and there has been no determination of liability.

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