Saber Healthcare Group and its related entities will pay $10 million for violations of the False Claims Act for knowingly “engaging in a systematic effort to increase Medicare billings” for rehabilitation therapy services that “were not reasonable, necessary, or skilled,” the Department of Justice announced.
The greater a patient’s needs, the higher the level of Medicare reimbursement. The highest level of Medicare reimbursement for skilled nursing facilities is for “Ultra High” patients, who require a minimum of 720 minutes of skilled therapy from two therapy disciplines (e.g., physical, occupational, speech), one of which must be provided five days a week.
According to the allegations in the case, U.S. ex rel. Wright et al. v. Saber Healthcare Holdings, filed in Virginia’s Eastern District Court, from January 2013 through March 2017, Saber attempted to skirt the system by allegedly “improperly establish[ing] general goals that all patients should be provided with the Ultra High level of therapy, regardless of the patients’ individual therapeutic needs and enforced that expectation by pressuring therapists to provide Ultra High therapy to each patient at nine facilities,” the Justice Department said.
According to the allegations, Saber:
- Established uniform expectations for Ultra High therapy in facility budgets;
- Pressured facility directors in weekly or daily calls to ensure therapists provided the Ultra High therapy to each patient;
- Prevented therapists from providing lower levels of therapy minutes if, in the therapists’ clinical judgment, a lower amount was warranted;
- Made therapists to report time spent on initial evaluations as therapy time in violation of Medicare policy; and
- Caused therapists to report time spent providing unskilled services as time spent on skilled therapy.
In addition to the civil settlement, Saber entered into a five-year corporate integrity agreement with the Department of Health and Human Services Office of Inspector General (HHS-OIG) that requires an independent review organization to annually assess the medical necessity and appropriateness of therapy services billed to Medicare.
The allegations resolved by this settlement arose from a whistleblower lawsuit filed under the False Claims Act, which permits private citizens to sue on behalf of the government and share in any recovery. The whistleblowers in this case, three former Saber rehabilitation therapists and therapy managers, will receive $1.75 million. The claims resolved by the settlement are allegations only, and there has been no determination of liability.