Chicago-Area Physical Therapy Center and 4 Nursing Facilities to Pay $9.7 Million to Resolve False Claims Act Allegations

Chicago-Area Physical Therapy Center and 4 Nursing Facilities to Pay $9.7 Million to Resolve False Claims Act Allegations

The U.S. Attorney’s Office in Chicago recently announced that a Chicago-area physical therapy center and four nursing facilities have agreed to pay $9.7 million to resolve civil allegations that they violated the False Claims Act by providing

unnecessary services to increase Medicare payments.

The settlements and consent judgments resolve allegations that skilled therapy service provider Quality Therapy & Consultation Inc. and its owner, Frances Parise, worked with the four skilled nursing facilities

— The Carlton At The Lake Inc., Ridgeview Rehab And Nursing Center, Lake Shore Healthcare And Rehabilitation Centre LLC and Balmoral Home Inc. — to increase Medicare reimbursements by “upcoding” their patients’ “Resource Utilization Group” scores. A “RUG” score indicates a patient’s care requirements

based on the level of physical-, occupational-, and speech-rehabilitation therapy the patient receives, and the complexity of the skilled nursing care the patient requires. The higher the RUG score, the higher the amount paid by Medicare to the nursing facility. The allegations also contend that the providers rendered skilled

therapy to patients who did not need it or could not benefit from it, as part

of an effort to bill the highest possible amount to Medicare.

The settlements and consent judgments resolve a civil lawsuit filed in U.S. District Court in Chicago by a former employee of Quality Therapy and Consultation under the qui tam, or whistleblower, provisions of the False Claims Act. The Act permits private citizens to bring lawsuits on behalf of the United States for false claims, and to share in any recovery. The United States intervened in the lawsuit prior to the settlements and consent judgments.

Per the terms of the settlements and consent judgments, Parise and the companies agreed to pay the following amounts:

Carlton at the Lake, located in the Buena Park neighborhood of Chicago: $3.63 million.

Lakeshore Healthcare, located in the Rogers Park neighborhood of Chicago: $2.73 million.

Balmoral Home, located in the Bowmanville neighborhood of Chicago: $1.17 million.

Quality Therapy and Consultation, formerly located in suburban Orland Park: $1.09 million.

Ridgeview Rehab, located in the Rogers Park neighborhood of Chicago: $1 million.

Frances Parise: $160,000. Parise also agreed to be excluded from all participation as a provider in Medicare, Medicaid and all federal health care programs for a period of five years.

The public is reminded that civil allegations are accusations only, and

there was no determination of liability as part of the settlements and consent judgments

.

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