False Claims Act - McKnight's Long Term Care News

False Claims Act

Jason Edgecombe, Baker Donelson

‘Extrapolation’ demonstrates False Claims Act liability in rehab

Recent FCA complaints have relied on a number of arguments to substantiate the submission of false claims for Medicare reimbursement: systematic upcoding to higher RUG levels due to corporate “pressure” on front line care providers; targeting therapy at or around RUG thresholds; increasing therapy during “look back” periods; and providing skilled therapy that was not required for improvement in functioning.

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