Nursing homes face quality-of-care scrutiny under the false claims act

Healthcare Financial Management

Volumn 55, Issue 1, 2001, Pages 54-58

  Landsberg, Barry S ^a   Keville, Terri D ^b  

^a Litigation and Employment Bus Unit   (United States)

^b Manatt Phelps and Phillips LLP   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CERTIFICATION; FORGERY; GOVERNMENT; HEALTH CARE QUALITY; LAW; MEDICARE; NURSING HOME; REVIEW;

CERTIFICATION; FACILITY REGULATION AND CONTROL; FRAUD; GUIDELINE ADHERENCE; INSURANCE CLAIM REPORTING; LIABILITY, LEGAL; LONG-TERM CARE; MEDICAID; MEDICARE; NURSING HOMES; QUALITY OF HEALTH CARE; UNITED STATES;

EID: 0035063462     PISSN: 07350732     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (13)

1. United States v. GMS Management-Tucker, Inc. et al., No. 96-1271 (E.D. Pa. 1996).
2. United States ex rel. Aranda v. Community Psychiatric Centers of Oklahoma, 945 F. Supp. 1485 (W.D. Ok. 1996).
3. United States v. Chester Care, Civil Action No. 98-CV-139 (E.D. Pa. 1998); United States v. City of Philadelphia, Civil Action No. 98-4253 (E.D. Pa. 1998); United States v. Greenbelt Nursing and Rehabilitation Center, Civil Action No. AW 98-3113 (D. Md. 1998).
4. Northern Health Facilities, Inc. v. United States, 39 F. Supp. 2d 563, 567, 571 (D. Md. 1998). (The deficiencies cited in the Greenbelt case did not immediately jeopardize the health or safety of residents.)
5. See, eg, United States ex rel. Mikes v. Straus, 84 F. Supp. 2d 427 (S.D.N.Y. 1999) (rejecting the notion that False Claims Act liability can be based on alleged failure to meet the standard of care and emphasizing that "the FCA is not a vehicle for regulatory compliance"); Luckey v. Baxter Healthcare Corporation, 2 F. Supp. 2d 1034, 1044-1045 (N.D. Ill. 1998) (same).
6. United States ex. rel. Hopper v. Anton, 91 F.3d 1261, 1265 (9th Cir. 1996); United States ex rel. Weinberger v. Equifax, Inc., 557 F.2d 456 (5th Cir. 1977), cert. denied, 434 U.S. 1035, 98 S.Ct. 768 (1978); United States ex rel. Joslin v. Community Health Care of Maryland, 984 F. Supp. 374 (D. Md. 1997) (home health); Luckey, supra, 2 F. Supp. 2d 1034, affirmed, 183 F. 3d 730 (7th Cir. 1999) (laboratory blood plasma tests); United States ex rel. Swafford v. Borgess Medical Center, 98 F. Supp. 2d 822 (W.D. Mich. 2000) (interpretation of ultrasound test); Lum v. Vision Service Plan, 104 F. Supp. 2d 1237 (D.Haw. 2000) (charging $7 copayment for vision care in violation of law).
7. United States ex rel. Mikes, supra, 84 F. Supp. 2d at 435.
8. United States ex rel. Roy v. Anthony, 914 F. Supp 1504 (S.D. Ohio, 1994); United States ex rel. Pogue v. American Healtbcorp, Inc., 914 F. Supp. 1507 (M.D. Tennessee, 1996).
9. United States ex rel. Thompson v. Columbia/HCA Healthcare Corp., 20 F. Supp. 2d (S.D. Tex. 1998), on remand from 125 F.3d 899 (5th Cir. 1997), vacating in part and remanding, 938 F. Supp. 399 (S.D. Tex. 1996).
10. United States v. NHC Healthcare Corp., 115 F. Supp. 2d 1149 (W.D. Mo. 2000). The court noted that, in the context of the motion to dismiss, it was required to give the benefit of any doubt to the government, which might have a difficult time actually proving its case. The court also mentioned the controversy over whether this use of the False Claims Act is proper, but left that issue for the appellate courts, Congress, or the relevant agencies to decide.
11. Pogue, supra, 914 F. Supp. at 1511.
12. See, eg, 64 Fed. Reg. 13354 (March 18, 1999) (publication of final regulations giving the Secretary of the Department of Health and Human Services expanded civil monetary penalty options and eliminating the maximum notification period for imposition of remedies); Robert Pear, "U.S. Toughens Enforcement of Nursing Home Standards," New York Times, December 4, 2000, at A21.
13. Delaney v. Baker, 20 Cal. 4th 23 (1999).