Three affiliated skilled nursing facilities in Illinois have agreed to resolve allegations that they violated the False Claims Act by submitting or causing the submission of false claims to the Centers for Medicare and Medicaid Services for medically unnecessary rehabilitation services. Under the agreement, Symphony Jackson Square LLC doing business as Symphony of Chicago West, Symphony Park South LLC doing business as Symphony of Morgan Park, and Symphony Midway LLC will pay the United States a total of $300,000. The settlement is based on their ability to pay.
Prior to October 2019, Medicare reimbursed skilled nursing facilities for therapy services to patients based on a patient’s resource utilization group (RUG). The RUG was to be determined by the amount of therapy and other services provided to the patient. The more therapy a patient received each week, the higher the RUG category, and the higher reimbursement a facility received. The United States alleged that, between Jan. 1, 2014, and Sept. 30, 2019, the skilled nursing facilities billed Medicare for physical therapy, occupational therapy, and speech pathology services provided to patients for longer than medically necessary and without regard for patients’ individual medical needs. These actions resulted in the submission of false claims based on inflated RUG levels.
“We expect nursing facilities to provide their patients, which include some of our most vulnerable citizens, reasonable and appropriate amounts of skilled rehabilitation therapy services,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “The Department is committed to holding accountable skilled nursing facilities that provide services based on their financial interests rather than the clinical needs of their patients.”
“Providing unnecessary medical services endangers the health of patients and raises the cost of treatment and insurance premiums for hard-working taxpayers,” said U.S. Attorney Andrew S. Boutros for the Northern District of Illinois. “The Chicago U.S. Attorney’s Office will remain vigilant in our efforts to deter those who seek to exploit critically important federal health care programs that are intended to help people in need – not cheats who seek to abuse and misuse our nation’s generosity.”
“Skilled nursing facilities that place profits above patient care betray the trust placed in them by vulnerable beneficiaries and the Medicare program,” said Acting Deputy Inspector General for Investigations Scott J. Lampert of the U.S. Department of Health and Human Services Office of Inspector General (HHS‑OIG). “HHS‑OIG will not tolerate the provision or billing of medically unnecessary services. We will continue working with our law enforcement partners to protect vulnerable beneficiaries and ensure taxpayer‑funded health care dollars are used appropriately.”
“The FBI is committed to ensuring that the nation’s nursing facilities are poised to provide top-notch, medically necessary care, not putting vulnerable patients at-risk or increasing the costs for vital health care,” said Special Agent in Charge Douglas DePodesta of the FBI Chicago Field Office. “While greed and fraud are often uncovered in law enforcement investigations, the FBI is uniquely poised with the personnel and resources to ensure that critical programs like Medicare and Medicaid are protected. Today’s announcement underscores the importance of the work that the FBI and our law enforcement and prosecutorial partners engage in to ensure offenders face accountability.”
The allegations resolved by the settlement arose from a qui tam or whistleblower lawsuit filed by Integra Med Analytics LLC. Under the False Claims Act, private parties can sue on behalf of the government and receive a portion of any recovery. The case is captioned United States ex rel. Integra Med Analytics LLC v. Symphony Healthcare LLC et al., No. 20-CV-0348 (N.D. Ill.). The whistleblower will receive $45,000 of the recovered funds.
The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the United States Attorneys’ Office for the Northern District of Illinois, HHS-OIG, and the FBI.
The matter was handled by Fraud Section Attorney Rachel Karpoff and Assistant U.S. Attorney Linda Wawzenski for the Northern District of Illinois.
The claims resolved by the settlement are allegations only and there has been no determination of liability.