Alleged upcoding carries very high price
Signature HealthCARE will pay $30 million to resolve allegations that it routinely placed residents at higher therapy levels to increase claims.
The June settlement with the U.S. Department of Justice also resolves allegations that Kentucky-based Signature submitted forged pre-admission certifications of patient need to Tennessee's Medicaid program.
The allegations stemmed from a federal whistleblower lawsuit brought by former Signature therapy employees Kristi Emerson and LeeAnn Tuesca in 2014.
complaint accused Signature of pushing patients into the ultra-high therapy category, often hitting the 720-minute per week exactly to maximize reimbursements. According to the Justice Department, Signature discouraged care above the threshold and pressured therapists to complete planned minutes even when patients were sick or disinterested.
The settlement resolves the $230 million case without an admission of guilt.
Signature HealthCARE President and CEO Joe Steier said the settlement “allows us to move forward in serving our residents and families with quality healthcare and a commitment to compassion.”