The federal government has accused a skilled nursing facility chain and one of the company’s executives of submitting false claims to Medicare and Medicaid by providing “grossly substandard” services that failed to meet even basic quality care standards.
The lawsuit, filed by the Department of Justice and the U.S. Attorney’s Office for the Middle District of Tennessee, names Vanguard Healthcare's corporate arm, six of its Tennessee facilities, as well as Mark Miller, who oversaw all of Vanguard’s long-term care facilities as director of operations. The government outlined a litany of care quality concerns that triggered False Claims Act (FCA) violations, including unsafe staffing ratios, failure to properly administer medications, substandard infection control practices, and unnecessary use of psychotropic medications and physical restraints.
“It is critically important that we confront nursing home operators who put their own economic gain over the needs of their residents,” Principle Deputy Assistant Attorney General Benjamin C. Mizer said in a DOJ release. “Operators who bill Medicare and Medicaid while failing to provide essential services will be held accountable.”
Prosecutors highlighted several disturbing examples of negligent care, including an instance in which one nurse was assigned to 80 patients. In that same facility, staff members reported that residents had not been bathed in days, that a deceased resident had gone unnoticed by staff members, and that nurses “borrowed pills” from other residents because medication was difficult to obtain. According to the complaint, these issues persisted despite state and federal surveys that highlighted quality-of-care deficiencies, and repeated complaints to management from staff members.
The government alleged that despite these issues, Miller oversaw a process in which Vanguard facilities forged Medicaid certification, as well as clinician signatures on preadmission screenings and patient assessment forms. Prosecutors cited multiple examples in which Medicaid paid tens of thousands of dollars for care that was either substandard or never provided at all.
Legal experts have been keeping a close eye on “worthless services” claims after another skilled nursing facility provider, Extendicare Health Services, paid $38 million to settle FCA charges in 2014. Earlier this year, the DOJ announced it was launching 10 regional Elder Justice Task Forces that would target nursing homes providing “grossly substandard care to their residents."