Ross Manor

Maine, ME 2015 Assisted Living / Long-Term Care

U.S. Attorney's Office District of Massachusetts OIG HHS False Claims Act Inflated Therapy Billing Rehabilitation Therapy Fraud

Penalty

$1.2 million

Outcome

Ross Manor, a Maine nursing home, paid $1.2 million to resolve allegations that it inflated Medicare claims for rehabilitation therapy services.

Details

Ross Manor (Maine) — Inflated Rehabilitation Therapy Claims, $1.2M Settlement (2015)

Outcome: Ross Manor, a nursing home in Maine, paid $1.2 million to resolve allegations that it submitted inflated Medicare claims for rehabilitation therapy services, violating the False Claims Act.

Ross Manor entered into a settlement agreement with the United States on March 30, 2015 to pay $1.2 million and resolve allegations of inflated rehabilitation therapy billing. The facility submitted Medicare claims for rehabilitation therapy — physical therapy, occupational therapy, or speech-language pathology — at levels that exceeded what the actual services warranted.

Inflated therapy billing involves claiming higher minutes, higher therapy intensity, or higher RUG categories than the documented services support. The enforcement action was handled through the District of Massachusetts and included both criminal and civil components. The $1.2 million settlement reflected the excess Medicare payments attributable to the inflated claims.

Primary Source: OIG Enforcement Record

How Crucible Prevents This

Crucible's therapy billing audit controls cross-reference claimed therapy minutes and RUG levels against functional assessment data and therapist time logs. Inflated therapy claims — where billed minutes exceed actual treatment — are detectable through automated reconciliation of therapy records against Medicare claim submissions.

Source: Maine Nursing Home to Pay $1.2 Million to Resolve Allegations Concerning Rehabilitation Therapy

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