Justice Department Alleges Nursing Home Chain’s “Ultra High Bill Targets” Caused Its Facilities to Submit False Medicare Claims

DOJ filed a False Claims Act complaint-in-intervention against HCR ManorCare alleging that ManorCare knowingly and routinely submitted false claims to Medicare and Tricare for rehabilitation therapy services that were not medically reasonable and necessary. ManorCare is owned by the equity management powerhouse The Carlyle Group, and it is one of the nation’s largest healthcare providers, operating approximately 281 skilled nursing facilities (SNFs) in 30 states.

According to the government’s FCA Medicare fraud complaint, ManorCare exerted pressure on its SNF administrators and rehabilitation therapists to meet “ultra high billing” goals that resulted in the provision of medically unreasonable and unnecessary services to Medicare and Tricare patients.

The government maintains that these billing goals were specifically designed to increase revenues without regard to the patients’ actual clinical needs. The underlying qui tam complaints allege that ManorCare threatened to terminate SNF managers and therapists if they did not administer the additional treatments necessary to qualify for the highest Medicare payments.

More information for whistleblowers is located at the Nolan Auerbach & White website.