Quality Therapy and Consultation Inc., its owner, Frances Parise, and four Chicago nursing homes have agreed to pay a combined $9.7 million settlement to resolve allegations that they were involved in a scheme to defraud Medicare. According to a whistleblower’s claims, the defendants routinely billed federal programs for services they never provided.
The Chicago-based nursing homes allegedly involved in the fraudulent scheme are Lakeshore Healthcare, Balmoral Home, Ridgeview Rehab, and Carlton at the Lake.
In 2014, Katherine Verhulst filed a False Claims Act lawsuit against her employer, Quality Therapy. Through her employment with the defendant as an occupational therapist, Verhulst became aware of the company’s alleged fraudulent practices.
According to the complaint, these involved misrepresenting the level of care patients needed and billing Medicare for medically unnecessary therapy. Under the FCA, Verhulst is entitled to a whistleblower award. In this case, she will receive $1.9 million for her assistance in recovering taxpayer funds.
According to prosecutors, the defendants systematically upcoded the “Resource Utilization Group” (RUG) scores for Medicare-covered patients. RUG scores refer to the level of care a patient requires in terms of physical, occupational, and speech rehabilitation therapy. The nursing homes and Quality Therapy allegedly conspired to increase Medicare billings by indicating patients needed the most skilled and costly types of therapy.
Verhulst’s former boss, Frances Parise, has agreed to pay a $160,000 share of the settlement. Additionally, she has been banned from any involvement with federal health care programs for the next five years.
Parise’s Linkedin profile still lists her role at Quality Therapy as current. The company’s Linkedin profile reads, “Quality Therapy has been providing therapy service in the Chicagoland area since 1989. Over twenty years later, the core philosophies and values that have allowed the Quality Therapy family to grow still remain in place.” Quality Therapy’s web address, however, now leads to an ad for ceiling fans.
Various federal agencies are currently targeting nursing home fraud and other forms of fraud against the elderly. For U.S. Attorney General William Barr, “Fraud against the elderly is on the rise. . . The Department of Justice is committed to ending the victimization of elders across the country.”
If you are a past or present healthcare worker has “original source” (inside) information about chronic understaffing, poor quality care or other serious violations of state or Medicare rules, contact us. We can help assure your information gets into the right hands. Not interested in a reward, you can also report your concerns to the Medicare fraud hotline at 1-800-MEDICARE.
Remember, calling the Medicare hotline does not qualify you for a cash reward or give you all the whistleblower protections and anti-retaliation provisions of the False Claims Act. Contact us directly if you would like to learn more. You can reach an operator by calling 888.742.7248 or by filling out our confidential online form.
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