A report released by the national law firm McDermott Will & Emroy addresses concerns related to necessary therapy services provided by skilled nursing facilities (SNFs). Legal experts point to the fact that both the Office of Inspector General and the Centers for Medicare & Medicaid Services have criticized the number of residents needing high level of care; therapy utilization trends have been identified as an acrea of concern in the OIG's 2015 Work Plan.
The report also identifies two recent False Claims Act cases that offer insight into the legal ramifications of the law for SNFs. An ongoing case involving Life Care Centers of America, in which the 200 SNF health system is accused of providing therapy services even when residents did not benefit from therap and targeting high resource utilization groups rates for larger reimbursement. In a 2010 case, Extendicare agreed to pay $38 million to settle claims that the SNF provider "clustered" and "ramped up" therapy sessions to bill Medicare at a higher rate.
In response, the report offers four takeaways for SNFs concerned with FCA liability. Report