In our recent article, “Is Your SNF on the Naughty List?” we discussed negative practice patterns that have been identified in recent lawsuits and settlement agreements. The “naughty list” is of skilled nursing facilities exhibiting “negative practice patterns” who may ultimately end up involved in lawsuits with the government alleging unreasonable and unnecessary therapy services billed to Medicare.

In that article, we referenced multiple cases that have settled, with links to each case so you can review the details independently. We also noted that there were a few cases “Still Out There,” meaning….. there are a few LARGE cases “in progress” alleging unreasonable and unnecessary therapy services. These cases are SNF chains owning over 200+ facilities each. These cases have not yet settled, though the circumstances listed in the lawsuits filed mirror the prior cases and site similar negative practice patterns.

  1. HCR ManorCare: This suit was filed 4/21/15 and involves a SNF operator of 281 facilities nationwide with in-house rehab.
  2. SavaSenior Care: This suit was filed 10/29/15 and involves a SNF operator of 200+ facilities nationwide with in-house rehab. No trial date set yet.

An Upate on the HCR ManorCare Case

Federal Judge Hilton of the Eastern District of Virginia has set the trial date for the lawsuit for January 22, 2018 so stay tuned for the outcome. It could be the biggest settlement yet!

Read the original Complaint Document Here: [It is Eye-Opening!]


Attorneys for the Plaintiff [Representing the brave therapists who came forward] just produced a Press Release that outlines key points in the case. Some of the following may hit home with therapists across the country who have left the SNF setting in recent years…

“I honestly felt that my license could be in jeopardy because the manager was pressuring me to treat inappropriate patients; it just felt wrong.” “I was told to basically show up and shut up.” “I was asked to perform unethical procedures and bullied into billing addt’l units. My job was threatened when I didn’t want to sacrifice my integrity.” “It’s all about getting minutes, minutes, minutes.” “[E]asy to leave the ‘corporate’ push of HCR.”

As quoted from the linked Press Release: “These are just some of the complaints that ManorCare’s corporate therapy managers received from therapists at ManorCare skilled nursing facilities (“SNFs”) upon these therapists’ resignations. These complaints, along with other evidence of the widespread provision of unnecessary, unreasonable, and unskilled therapy, resulted from a corporate strategy ManorCare adopted between 2006 and 2012. That strategy was simple: to game the Medicare system, by pressuring and manipulating its employees into providing thousands of hours of unnecessary and useless therapy, so that ManorCare could reap millions of dollars in improper reimbursements.”

So How is ManorCare Taking All of This? 

Well, a look at the Case Docket Details – since 2009 shows that there has been quite a bit of back and forth. [Yes….this started in 2009!!]

However, on November 2, 2017, the U.S fought back once again to  counter HCR ManorCare claims of no wrongdoing. You can read the UNITED STATES’ MEMORANDUM IN OPPOSITION TO DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT here.

In this Memorandum, the U.S. is reiterating the negative practice patterns and techniques HCR ManorCare was reported to have used, including the following areas:

  • Medicare Power Ratings – Tracking # Ultra RUGS and pushing for higher %
  • Medicare Entitlement Training – Training staff to find any means to engage Part A and full 100 day benefit
  • Goals for Ultra High RUGs – Setting targets for each facility to hit for high % of RU
  • Group Therapy – Maximizing Group even when not clinically indicated [this was back when Group Minutes were not divided by 4]
  • Modalities – Using modalities as “minutes insurance” or an easy way to “get more minutes”
  • Length of Stay – Pushing for a longer length of stay, controlling discharge dates
  • Action Plans and Employee Performance Evaluations – Manipulating staff that were falling below RU targets or “pulling the ethics card”
  • Operations Staff’s Involvement in Therapy Decisions – RUG categories not set by clinicians involved in resident care
  • Failure to Prevent Unnecessary, Unreasonable, and Unskilled Therapy- Complaints not investigated, appropriate type of audits not done

HCR ManorCare attorneys continue to fight, including attempting to discredit therapists involved in the case. A recent opposition was filed November 2nd entitled DEFENDANTS’ MEMORANDUM IN OPPOSITION TO RELATOR RIBIK’S MOTION FOR PARTIAL SUMMARY JUDGMENT ON THE PUBLIC DISCLOSURE BAR AND ORIGINAL SOURCE EXCEPTION, in which attorneys are attempting to get a ruling to deny the motion of the occupational therapist involved.

So What Can You Do?

If you see something…say something. Take notice of your facility practice patterns and if any of them mirror the above, or those outlined in our last article, ask questions. Know the rules and hold others accountable. As a licensed clinician, no one can “make you do something.” We are all responsible for our own actions. Take command of yours.

Does your facility use any of these techniques?

1. Providing different levels of care based solely on insurance (Med Part A residents fall into Ultra and HMO residents do not exceed RV or RH)
2. Cutting down or adding minutes as ARD is approached to hit RUG exactly
3. Scheduling LCD for day prior to COT checkpoint and cutting minutes as it approaches since this never shows up on an MDS
4. Score Ultra RUG on the 5 day, drop RUG on 14 day and use the next COT to get Ultra RUG back without payment penalty
5. When 1 discipline discontinues, the minutes of another increases without clinical basis

Therapists and nurses across the country have made their voices heard over the past few years by filing  qui tam lawsuits in an attempt to bring negative practice patterns to light and try to help pave the way for those therapists in the SNF setting who are hanging in there because of their dedication to their patients and their profession. No matter how you slice it, we are all in this together.

Any questions, Just Ask!

In Your Corner,

Montero Therapy Team

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