The United States has filed a False Claims Act case against Tennessee-based nursing home company, Vanguard Healthcare LLC, as well as Vanguard Healthcare Services LLC, and six of its nursing facilities. See United States vs. Vanguard, et al.,case no. 3:16-cv-2380 (M.D.Tenn 2016). The lawsuit alleges that the defendants were responsible for the submission of false claims to Medicare and TennCare (Tennessee’s Medicaid program) for skilled nursing home services that were either non-existent or grossly substandard. The case represents the commitment of the U.S. Attorney’s office to combat elder abuse, neglect, and financial exploitation, especially as they impact Medicare and Medicaid beneficiaries.
Specifically, the complaint alleges that the Vanguard nursing facilities in Tennessee failed to provide the most basic and essential skilled nursing services to their residents, which led to pressure ulcers, dehydration, and malnutrition. The absence of appropriate care included chronic staffing deficiencies as well as shortages of critical medical supplies. The complaint describes the failure to provide standard infection control, failure to administer medication to residents as prescribed by their physicians, failure to provide wound care, and failure to adequately manage residents’ pain. Further, there are allegations that staff was providing unnecessary and excessive psychotropic medications to residents and using unnecessary physical restraints on residents. The lawsuit also names Vanguard’s former Director of Operations for knowing that the care was inadequate and failing to correct the problems.
Beyond the false claims for non-existent or worthless services, the complaint also alleges that some of the Vanguard facilities fraudulently submitted falsified Pre-Admission forms to TennCare, in order to receive payments. These required forms were allegedly submitted with forged physician and nurse signatures.
Prior to this, in 2011, Vanguard settled a whistleblower lawsuit in federal court stemming from allegations that Vanguard and its subsidiaries were defrauding Medicare and Medicaid by double-billing, submitting clams for free items that had been received at no cost, and failures to disclose related parties.