Nursing Home Chain Accused of Overbilling

According to Fox Business News, the federal government has joined three citizen whistleblower lawsuits against a national chain owner of nursing homes, HRC ManorCare. The government joined the lawsuits filed by former ManorCare employees who witnessed their former employer billing the government for services that were not medically necessary or were not skilled in nature and did not meet even the minimum requirements for care provided in skilled nursing facilities.

According to ManorCare's website, the company operates 280 skilled nursing facilities and rehabilitation centers nationwide under the names Heartland, ManorCare Health Services and Arden Courts.

In its complaint, the government alleged ManorCare would set "ultra-high" billing targets for its skilled nursing facilities without regard to its patients' actual medical needs to maximize ManorCare's revenue. Ultra-high billing is the highest daily rate that Medicare will pay for rehabilitation therapy. It applies to patients who require skilled rehabilitation therapy for a minimum of 720 minutes per week from at least two therapy disciplines.

The government claims in its lawsuit that ManorCare engaged in a nationwide scheme to bill at the ultra-high level whether it was medically appropriate or not. If a jury agrees with the government and finds ManorCare responsible for this overbilling, ManorCare will be responsible for paying back the taxpayers for the overbilling and the former employees-whistleblowers will share in the proceeds for calling attention to the illegal activity of the nursing home chain.

http://www.foxbusiness.com/markets/2015/04/21/us-jumps-into-whistleblower-cases-that-accuse-nursing-home-chain-overbilling/

If you suspect you or a loved one's nursing home charge or bill is fraudulent, Medicare recommends you contact the provider and ask them to clarify or explain their bill.

If the nursing home refuses to explain their bill and you can clearly identify wrongdoing, the government requests you call 1-800-MEDICARE (1-800-633-4273) to report fraud.

Before you call 1-800-MEDICARE have this information ready:

• The provider's name and any identifying number you may have

• The service or item you're questioning

• The date the service or item was supposedly given or delivered

• The payment amount approved and paid by Medicare

• The date on your "Medicare Summary Notice" (MSN) mailed to your residence after a billing request is received.

• Your name and Medicare number

• The reason you think Medicare shouldn't have paid

• Any other information you have showing why Medicare shouldn't have paid for a service or item

http://www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse/report-fraud/reporting-fraud.html

Carlson & Burnett attorney, Rich Hitz frequently addresses audiences in Nebraska and Iowa on nursing home abuse and neglect issues.

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