A California-based therapy company has agreed to pay $2 million to quash allegations that it overbilled for services provided at 11 skilled nursing facilities.
In the settlement announcement Friday, the Department of Justice said Interface Rehab submitted Medicare Part A claims for medically “unreasonable and unnecessary Ultra High” therapy levels.
The allegations, built in part on testimony from a whistleblower within the company, stretched from Jan. 1, 2006. through Oct. 10, 2014.
Federal officials said this settlement was connected to a case against Longwood Management, which last year agreed to pay $16.7 million to the government over alleged upcoding at 27 California facilities. The settlement announced Friday resolves Interface’s role in that case.
The Department of Justice alleged in the most recent settlement that Interface pressured therapists to increase the amount of therapy provided to patients to meet “pre-planned targets” for Medicare revenue. These alleged targets could only be achieved by billing for a high percentage of patients at the Ultra High level without regard to patients’ individualized needs, the government said.
The switch to the Patient Driven Payment Model in 2019 removed therapy billing levels and put less focus on rehab services as a basis for billing in the skilled nursing setting.
A voicemail left at Interface’s corporate headquarters seeking comment was not returned by deadline.
“This settlement reflects our continuing efforts to protect patients and taxpayers by ensuring that the care provided to beneficiaries of government-funded healthcare programs is dictated by clinical needs, not a provider’s fiscal interests,” Acting Assistant Attorney General Brian M. Boynton said in a press release. “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 interests of their patients.”
The facilities named as part of the upcoding settlement are: 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, San Gabriel Convalescent Center and Whittier Pacific Care Center.
Whistleblower Keith Pennetti, former director of rehab at Interface, will receive $360,000 of the settlement proceeds.