A settlement has been reached to resolve False Claims Act allegations against Encompass Health Corporation.
The allegations arose from a lawsuit that claimed Encompass Health Corporation provided inaccurate information to Medicare to earn higher reimbursement and admitted patients unnecessarily.
According to the government, Encompass, the country's largest inpatient rehabilitation provider allegedly provided the inaccurate information so that some of its facilities could maintain their status in order to earn its higher reimbursement rate. Medicare and Medicaid use patients' diagnoses to determine whether a facility should be classified as an inpatient rehabilitation facility and to determine the proper reimbursement level.
Furthermore, beginning in 2007, some Encompass inpatient rehabilitation facilities falsely diagnosed patients with what they referred to as "disuse myopathy" when there was no clinical evidence for the diagnosis. This was allegedly done to ensure compliance with Medicare's rules regarding classification as an inpatient rehabilitation facility and to increase Medicare reimbursement. Additionally, Encompass inpatient rehabilitation facilities also allegedly admitted patients who were not eligible for admission because they were too sick or disabled to participate in or benefit from intensive inpatient therapy.
“This settlement demonstrates our commitment to ensuring that those who participate in federal healthcare programs follow the rules,” said Assistant Attorney General Jody Hunt for the Department of Justice’s Civil Division. “Medicare and Medicaid providers who seek to profit inappropriately at the expense of taxpayers will be held accountable.”
The whistleblowers collective share of the settlement will be $12.4 million.
