US Joins Whistleblower Case Alleging Medicare Fraud at Large Nursing Home Chain

Whistleblower Case Against Nursing Home Chain for Medicare Fraud Will Go To Court

Whistleblower CaseThe US Department of Justice announced on Tuesday, April 21st, that it would join a whistleblower case filed against a large nursing home chain, HCR Manorcare, which alleges the company committed Medicare fraud.

The whistleblower case alleges that HCR Manorcare’s numerous chains, originally filed in Virginia by an occupational therapist in 2009 who used to work for the company, systematically overbilled Medicare for services, and put sick and frail patients through arduous regimens of physical and occupational rehabilitation just to increase revenue.

According to documents in the case, Manorcare routinely pressured administrators at nursing homes, assisted living, and skilled nursing/rehab facilities to meet financial targets by billing for unnecessary care. In some cases, this borders on elder abuse, as frail and helpless patients were sent to physical and occupational therapy when the treatments would not do them any good.

Manorcare primarily operates under Heartland and Arden brands. The company has denied the Medicare fraud charges.

“The government bases its allegations on retrospective analyses performed by a few alleged experts who have never cared for, spoken with or even seen the patients in question. Instead, these alleged experts second-guess the hands-on clinical judgment of tens of thousands of experienced, licensed, caring and compassionate doctors, nurses and therapists who actually provided care to our patients,” the company said in a statement issued Tuesday.

However, the whistleblower’s attorney said that the thorough federal investigation into the charges “uncovered an astonishing amount of really bad facts.” These include all Manorcare patients being placed in the highest tier for rehabilitation, whether they needed it or not. Because the patients were listed at the highest tier, the company was able to increase the amount it billed Medicare for the services. The federal investigation found that in 2006, Manorcare billed at the top rehab rate for 39% of its patients nationwide; by 2009, that amount had increased to 80% of the patients.

In one tragic case, an 85-year-old hospice patient was unnecessarily put through 100 days of physical therapy, despite being listed as hospice-only and described by his therapist as “medically fragile.” He was placed in hospice care only after Manorcare billed Medicare for 100 days of therapy, the total amount they could bill for his condition.

While the US DOJ has not listed the amount they believe Medicare has been overcharged by Manorcare, they did state that between January 2006 and May 2012, Manorcare’s 281 skilled nursing facilities received $6 billion from Medicare.

The Strom Law Firm Represents South Carolina Whistleblowers with Knowledge of Medicare Fraud

If you are a current or former employee of a nursing home, assisted living facility, hospice, or other medical institution that receives federal reimbursement for healthcare, and you believe you have witnessed Medicare fraud, you could file a whistleblower lawsuit to prevent further fraud against the federal government. The South Carolina qui tam/whistleblower attorneys at the Strom Law Firm can help. Although you do not technically need an attorney to file a whistleblower lawsuit, navigating the process can be difficult. The Strom Law Firm understands the complexities of qui tam law and can help protect your interest. We offer a free case evaluation to discuss your potential case, so contact us today. 803.252.4800


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