$819K Settlement In Wynnewood Nursing Home Over Billing Practice: Feds

WYNNEWOOD, PA — A Wynnewood skilled nursing facility has agreed to a large settlement after it provided medically unnecessary rehabilitation therapy to residents to maximize revenue, and without prioritizing clinical needs.

United States Attorney Jacqueline C. Romero said Old Man’s Home of Philadelphia, doing business as Saunders House in Wynnewood, will pay $819,640 to settle the claims.

The settlement resolves allegations in a whistleblower complaint filed in federal court in the Eastern District of Pennsylvania under the qui tam provisions of the False Claims Act.

These provisions allow private citizens to bring civil actions on behalf of the United States and share in any recovery.

The whistleblower, a physical therapist assistant who provided physical therapy services at Saunders House through his employment with a contracted therapy provider, generally alleged that Saunders House over billed federal healthcare programs such as Medicare for therapy services.

He alleged that Saunders House overbilled federal healthcare programs such as Medicare for therapy services provided; billed for services not provided; billed for unreasonable, unnecessary, and sometimes harmful therapy; and allowed the therapy provider to manipulate clinical services to maximize billing.

During the relevant time period, Medicare Part A paid for services rendered to a beneficiary in a skilled nursing facility at a daily rate based, in part, on a Resource Utilization Group (RUG) to which the beneficiary is assigned.

Each distinct RUG was intended to reflect the anticipated costs associated with providing nursing and rehabilitation services to beneficiaries with similar characteristics or resource needs.

The highest reimbursement level was Ultra High or RU.

The resolution is based on claims that Saunders House caused the submission of false claims for Ultra High RUG therapy levels despite evidence that the RU level of therapy was not reasonable or necessary for the respective patients.

"Focusing on profits over the needs of individual patients violates the public trust and creates a potential for harm of some of the most vulnerable among us," Romero said. "It also shifts taxpayers’ funds away from the vital services of law-abiding therapy providers. We thank the whistleblower for helping to make the government aware of these allegations. We also thank Saunders House for fully cooperating with the government’s investigation—that cooperation was taken into account when determining an appropriate resolution of these allegations."