England Associates, L.P. d/b/a New London Health Center (“New London”) agreed to pay $400,000.00 to resolve allegations that it knowingly submitted false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary, and skilled. The settlement amount was based on New London’s ability to pay. The government alleged that between January 1, 2011 and November 30, 2014, New London engaged in various practices that resulted in the submission of claims for unreasonable, unnecessary, and unskilled services to Medicare patients, including: (1) presumptively placing patients in the Ultra High therapy reimbursement level, rather than relying on individualized evaluations to determine the level of care most suitable for each patient’s clinical needs; (2) providing the minimum number of minutes required to bill at a given reimbursement level while discouraging the provision of additional therapy beyond that minimum threshold; (3) ramping up therapy minutes only during the period in which billing levels were set; and (4) pressuring therapists and patients to complete the planned minutes of therapy regardless of patient need, and in some cases, for patients for whom such therapy would have been dangerous. The Government alleges that these arrangements violated the False Claims Act, 31 U.S.C. § 3729, et seq.
