Saber Healthcare Group, LLC will pay $10 million to settle a federal investigation into its rehabilitation therapy practices, the Department of Justice announced Tuesday.
Investigators had accused the Bedford Heights, Ohio-based Saber of working to artificially boost its Medicare income by pressuring therapists to place residents in the “ultra high” category, a classification that brought the greatest reimbursement under the old Resource Utilization Group (RUG) Medicare payment model for nursing homes.
“Patients are entitled to individualized health care services appropriate to their specific medical needs,” assistant attorney general Jody Hunt said in a statement announcing the settlement. “When skilled nursing facilities provide rehabilitation therapy services based on maximizing revenue rather than what is necessary for their patients, we will not hesitate to hold them accountable.”
The settlement applies to therapy services provided between January 2013 and March 2017 at facilities in Ohio, Pennsylvania, North Carolina, and Virginia.
In addition to the $10 million payment, Saber agreed to enter a corporate integrity agreement (CIA) with the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) for five years. Under that arrangement, an independent organization will review “the medical necessity and appropriateness of therapy services billed to Medicare.”
By reaching the settlement, the federal government did not make a determination of Saber’s liability in the matter, and the company did not admit to any wrongdoing; as a result, all of the DOJ’s accusations remain allegations and not findings of fact.
False Claims Act cases regarding the improper provision of therapy services under the RUG system were a relatively common occurrence for nursing home operators.
The new Patient-Driven Payment Model (PDPM), which took effect last October 1, sought to remove the financial incentive for providing unnecessary therapy by eliminating the connection between therapy minutes and Medicare dollars; PDPM instead attempts to reimburse providers based on each resident’s specific health care needs.
Under the qui tam provisions of the False Claims Act, the three former Saber employees who alerted the federal government to the allegations will split $1.75 million of the $10 million settlement cash.