A nursing home operator must stand trial on allegations that three of its facilities in Ohio and Pennsylvania were grossly negligent in caring for residents and submitted false claims for Medicare payment, a federal judge ruled.
The Ohio-based American Health Foundation sought to dismiss False Claims Act allegations filed by the US Department of Justice last year, arguing that the facilities didn’t render “entirely” worthless services.
But Judge R. Barclay Surrick, writing for the US District Court for the Eastern District of Pennsylvania, roundly rejected that argument and others and ordered the case to move forward on March 31.
“Defendants argue that, because they billed the government for a bundle of services, rather than an individual fee for each service, the government must prove that every service in the entire bundle was worthless,” Surrick wrote. “We agree with the Government that this argument is illogical. … A bundle of services can, on average, be worthless even if some of them were administered properly.”
Surrick’s ruling was a harsh rebuke for American Health Foundation ahead of what could be a challenging trial.
“[T]he allegations against Defendants rise to the level of gross-negligence necessary to deem their services worthless,” Surrick wrote. “Whether Medicare and Medicaid recipients were fed, changed, washed, lived in a habitable environment, given proper medical care, and prevented by competent staff from killing themselves is certainly ‘central to the decision about how to spend public funds’ and goes ‘to the very essence of the bargain’ Defendants made with the Government.”
Even if the facilities’ services weren’t “worthless,” Surrick said the falsity element of the False Claims Act could be met by the company “falsely affirming that they were in compliance with federal regulations required to receive Medicare and Medicaid reimbursements.”
Federal charges last summer detailed numerous allegations of significant negligence and abuse at Cheltenham Nursing & Rehabilitation Center, a 255-bed nursing home in Philadelphia, PA; The Sanctuary at Wilmington Place, a 63-bed nursing home in Dayton, OH; and Samaritan Care Center, a 56-bed nursing home in Medina, OH.
A woman who answered the phone at American Health Foundation Tuesday declined to comment on the case to McKnights Long-Term Care News.
Justice officials allege that the three facilities failed to follow infection control protocols, did not maintain adequate staffing, and provided “grossly substandard services” that housed residents in dirty conditions, subjected residents to verbal abuse, and failed to provide psychiatric care.
Surrick’s ruling contains lengthy descriptions of alleged abuse and neglect suffered by residents at each facility, some of which were added to the original charges in an amended federal complaint. Allegations cover pressure ulcer, dental , dialysis, pharmacy, housekeeping, dining and severe understaffing issues, among others.
