HCR ManorCare, one of the largest nursing home chains in the country has been sued by the government under the False Claims Act. The lawsuit, which is a consolidation of three different lawsuits, alleges that ManorCare routinely and knowingly submitted claims to Medicare and Tricare that were false. These claims included rehabilitation services that were deemed not medically necessary or reasonable, as well as allegations that the chain put pressure on administrative employees to bill for unnecessary care in order to meet financial goals.
The complaint also lists other allegations against the nursing home chain, including:
Each of the three cases was filed under the qui tam provisions in the False Claims Act, which are also known as the whistleblower provisions. These provisions allow private individuals to file a lawsuit on behalf of the government’s interests and claim a portion of any funds recovered from the false claims. The False Claims Act also allows the government to intervene in these types of lawsuits, which is what has occurred in this case.
The government’s involvement is directly related to helping combat fraud in healthcare in an effort to protect the funds of Medicare, Medicaid and Tricare, so that they are available for those who need them. If ManorCare is found guilty in this case, they will be liable for three times the amount that the government is claiming in losses, plus additional civil penalties.
HCR ManorCare is one of the largest nursing home chains in the country, with more than 280 skilled nursing facilities that provide rehabilitation, assisted living and nursing home care in 30 states. According to their website, ManorCare denies that any of these allegations are true, saying that:
“Rather, this lawsuit is the result of a billing dispute between our company and the federal government that stems from the government’s view that our industry as a whole is providing a level of care to Medicare rehabilitation patients that exceeds the government’s expectations, despite the fact that these services were ordered by licensed physicians and delivered by licensed therapists.”
Additionally, the company cites the fact that all of their billing related to Medicare is submitted and approved through the Centers for Medicare & Medicaid Services’ third-party intermediaries, which found that the services provided by ManorCare were considered both compliant and medically necessary.
Unfortunately, this is not the first case to be presented against ManorCare in recent years. In 2009, an 87-year old woman died only 19 days after admission into a ManorCare facility in West Virginia. The woman in question not only failed to receive proper nutrition and hydration, which both contributed to her death, but there was also evidence of head trauma and other signs showing a lack of adequate care.
In 2011, ManorCare of Libertyville was found to have several violations during a DHHS inspection, including neglect, abuse, a lack of criminal background checks for employees, and allowing a patient who was a known sexual predator to share a room, resulting in complaints from the other patient.
All of these cases, violations and allegations are serious, and require consideration when choosing this or any other nursing home facility for your loved ones. If you suspect abuse or improper care, make sure to report the facility to the proper authorities.