HCR ManorCare, Medicare Fraud, Michigan 2024
The government has intervened in three False Claims Act lawsuits and filed a consolidated complaint against HCR ManorCare, one of the nation’s largest healthcare providers, alleging that the company knowingly and routinely submitted false claims to Medicare and Tricare for rehabilitation therapy services that were not medically reasonable and necessary.
ManorCare operates approximately 281 skilled nursing facilities (SNFs) in 30 states and is owned by The Carlyle Group. The government’s complaint alleges that ManorCare exerted pressure on SNF administrators and rehabilitation therapists to meet unrealistic financial goals that resulted in the provision of medically unreasonable and unnecessary services to Medicare and Tricare patients.
“The government is committed to ensuring that healthcare providers who pressure their employees to provide medically unnecessary services to Medicare beneficiaries and Tricare recipients, solely to increase their own profits, are held accountable,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division.
The government’s complaint alleges that ManorCare set prospective billing goals designed to significantly increase revenues without regard to patients’ actual clinical needs and threatened to terminate SNF managers and therapists if they did not administer the additional treatments necessary to qualify for the highest Medicare payments.
“We strive for a system whereby health care providers provide reasonable and necessary services without overbilling Medicare for unreasonable and unnecessary services,” said U.S. Attorney Dana Boente of the Eastern District of Virginia.
U.S. Attorney Barbara McQuade of the Eastern District of Michigan added, “We want to ensure that taxpayer dollars are used to pay for health care for Americans that need it, not to unjustly enrich health care companies.”
The three consolidated lawsuits were filed under the qui tam provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery.
The government’s intervention in these matters illustrates its emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.
Key Facts
- State: Michigan
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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