Michigan-based staffing company involved in Medicare fraud.
Encore Rehabilitation Services LLC, a staffing company based in Farmington Hills, Michigan, is set to pay $4.03 million to resolve allegations that it “violated the federal False Claims Act by engaging in policies and practices that forced Autumn Woods Healthcare Facility in Warren, Bay Shores Senior Care and Rehab Center in Bay City and Medilodge of Yale to submit fraudulent Medicare claims for rehabilitation services,” according to U.S. Attorneys. The company provides rehabilitation services to patients at over 600 health care facilities across thirty states.
“Encore’s actions over several years resulted in the provision of unreasonable, unnecessary, or unskilled rehabilitation therapy or the recording of therapy minutes as individual therapy when concurrent or group therapy was actually provided,” officials stated.
“Today’s 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,” said Deputy Assistant Attorney General Michael Granston of the Department of Justice’s Civil Division in the release. “Rehabilitation therapy companies provide important services to our vulnerable elderly population, but they will be held to account if they knowingly provide patients with unnecessary or ineligible services.”
“Billing federal healthcare programs for medically unnecessary rehabilitation services not only undermines the viability of those programs, it exploits our most vulnerable citizens,” said U.S. Attorney Matthew Schneider for the Eastern District of Michigan. “We are committed to working with our federal partners to protect both vulnerable Michiganders and these helpful healthcare programs.”
“The resolution announced today demonstrates my office’s commitment to aggressively pursuing providers who utilize fraudulent practices to knowingly put their own financial self-interest over a duty to patients,” said U.S. Attorney Andrew Byerly Birge for the Western District of Michigan. “It is imperative that providers make healthcare decisions based upon a patient’s need for services rather than a self-serving desire to maximize financial profits.”
“The submission of claims for unreasonable, unnecessary or unskilled rehabilitative services is improper and unacceptable,” said Special Agent in Charge Lamont Pugh III, HHS-OIG – Chicago Region. “The public expects that proper services will be provided and that taxpayer dollars will not be wasted. OIG Corporate Integrity Agreements help to ensure that contracted providers, who have caused improper billing practices change their behavior.”
The settlement comes in response to whistleblower statements, referred to as qui tam under the False Claims Act, by former staffing company employees Linda Anderson, Reza Saffarian and Audrey Theile, and Adam LaFerriere. The federal act permits “private parties to file suit on behalf of the United States and to share in any recovery.” The staffing company has also entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health & Human Services, Office of Inspector General which requires the company to establish risk assessment and internal review process. The matter was handled by the DOJ Civil Division’s Commercial Litigation Branch, the U.S. Attorneys’ Offices for the Eastern and Western districts of Michigan, and the HHS-OIG.