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For-Profit Nursing Home Accused of Medicare Fraud

Posted in Nursing Home Violations on June 4, 2013

Medical-fraud-imageYet another national, for-profit nursing home chain, Life Care, is being sued by the Justice Department over allegations of overbilling Medicare. Life Care is accused of billing nearly 68 percent of its Medicare rehabilitation days at the highest level, nearly twice the national average of 35 percent. CBS This Morning has spent months examining Life Care’s rehabilitation services and claims. It recently presented a scathing report, based in part on statements by at least a half dozen former Life Care employees.

A former assistant manager speech therapist at multiple Life Care locations told CBS This Morning that she eventually quit the facility because she felt that its insistence on unnecessary rehabilitation services was detrimental to the health of the nursing home residents. By the time she left, she said, nearly 40 percent of her work was neither reasonable nor necessary. In addition, she said, in many cases the nursing home would simply refuse to let patients leave, because they wanted to continue to bill Medicare for services!

In another piece of evidence, the entire rehab staff at the Life Care Center of Estero in Florida signed a letter to the boss which read, in part, “we have been encouraged to maximize reimbursement even when clinically inappropriate…”

There are six Life Care Centers in Kentucky: Laurel Creek Health Care Center, in Manchester; Life Care Center of Bardstown, in Bardstown; Life Care Center of La Center, in La Center; Life Care Center of Morehead, in Morehead; Mountain View Health Care Center in Elkhorn City and Parkview Nursing and Rehabilitation Center in Paducah. According to the CMS website, Life Care Center of Bardstown and Parkview Nursing and Rehabilitation each had three stars on their latest inspection report – that’s average. Life Care Center of La Center and Life Care Center of Moreshead both had two stars – below average. And Laurel Creek Health Care Center and Mountain View Health Care Center both received only a single star and are rated as much below average.

In general, studies show that for-profit nursing homes provide fewer staffing hours and a lower quality of care than nonprofit or government-run nursing homes.

Unfortunately, Life Care Centers is not the only nursing home chain being suspected of overbilling Medicare. The most recent report from the U.S. Department of Health and Human Services inspector general found that industry-wide, a quarter of all Medicare payments to nursing homes are made in error. When nursing homes charge for services they don’t provide, they increase the cost of Medicare and Medicaid to the taxpayer. These programs are already overextended. Fraud puts them in even more jeopardy. Equally seriously, if nursing home residents are given services they don’t need, it can make them uncomfortable, confused or disoriented. It can even endanger their health. The patients’ records are also likely to be inaccurate, which may cause doctors to misdiagnose them later.

Nursing homes have an obligation to provide responsible care to patients who need it – and not offer unnecessary services to patients simply so that they can charge more money. Keeping seniors in a nursing home when they are ready to be discharged simply to get more funds out of Medicare is unconscionable.

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About Hughes & Coleman

Since establishing the firm of Hughes & Coleman in 1985, co-founding partners J. Marshall Hughes and Lee Coleman have been dedicated to protecting the rights and interests of Kentucky and Tennessee nursing home abuse and neglect victims as well as the families who care deeply about their elderly loved ones. This area of practice is also known as elder law or elder abuse law.

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