PA Nursing House Settles Overcharge Lawsuit to $819,000

A Pennsylvania nonprofit nursing home that is in the process of being sold has agreed to settle a whistleblower lawsuit alleging it overcharged the government $819,000 for physical therapy services.

Saunders House, located in Wynnewood, a suburb of Philadelphia, first became the target of allegations of false claims in 2015.

Gerard Carson, a contract physical therapist at the facility, and four others in the Philadelphia area sued Saunders, alleging that the facility billed state health programs for “medically unnecessary rehabilitation therapies for residents to maximize revenue and without prioritizing clinical needs” according to a statement from the US Attorney’s Office in Philadelphia.

The US Attorney’s Office in Philadelphia announced the resolution of the lawsuit on Friday.

US Attorney Jacqueline Romero thanked Saunders House for its cooperation in the government investigation. “This collaboration has been taken into account in determining an appropriate resolution to these allegations,” Romero said in a statement.

Meanwhile, Saunders House attorney Paula G. Sanders of Post & Schell PC said in a prepared statement that her client did not admit liability in the matter and decided to settle the case at this time “because of continued operations.” was at risk without completing a sale.”

“We believe our actions were appropriate in all cases because we have relied on our contracted therapy company to provide medically necessary therapy services to our residents,” Sanders said, noting that at the time of the whistleblower complaint, Saunders’ services House were provided by a third party therapy service provider.

However, the investigation included allegations that Saunders House filed claims for therapy for patients in the now-defunct Ultra High RUG therapy category, despite evidence that the level of therapy “was not appropriate or necessary for the particular patients.”

“Focusing on profits over the needs of individual patients violates public trust and creates potential harm for some of the most vulnerable among us,” Romero said. “It also shifts taxpayer money away from the vital services of law-abiding therapy providers.”

As of September 30, 2021, the department had obtained more than $5.6 billion in settlements and judgments in civil cases involving fraud and false allegations against the government.

Prior to the introduction of the patient-driven payment model in 2019, long-term care therapy services were under scrutiny for years over alleged overbilling practices. Implementation of PDPM has been associated with a decrease in the volume of rehabilitation therapy utilization without impacting patient outcomes, according to a January 2022 study published in the JAMA Health Forum.

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