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Criminal Justice & Legal System

Toledo-based nursing and rehab company accused of filing false Medicare claims

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Steve Carmody
/
Michigan Radio

The federal government is accusing one of the largest providers of nursing home and rehabilitative care in Michigan of providing medically unnecessary therapy.

The civil lawsuit was filed under the Federal False Claims Act.

Toledo-based HCR ManorCare operates dozens of nursing, rehab and other facilities in Michigan and more than 200 nationwide.

The U.S. Justice Department says ManorCare knowingly and routinely submitted false claims to Medicare and Tricare. The case is based on three whistleblower complaints filed in Virginia.

The government’s complaint alleges that ManorCare, which is owned by The Carlyle Group, 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. ManorCare allegedly 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. ManorCare also allegedly increased its Medicare payments by keeping patients in its facilities even though they were medically ready to be discharged.

The company issued a statement labeling the lawsuit “unjust” and pledged to “vigorously defend” itself in court.

The government made its decision to intervene in this lawsuit despite our full cooperation with its investigation. Our cooperation included producing information that we believe refutes the basic claims contained in the lawsuit. Unfortunately, the government disagreed and instead proceeded with its case.

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