Substandard Care Allegations Lead to Medicare Fraud Charges

The company that operates “Golden Living” nursing homes agreed to pay $613,300 to resolve allegations that it provided inadequate and worthless wound care services to residents.

The government claimed that GGNSC Holdings LLC, the operator of skilled nursing facilities under the “Golden Living” name, fraudulently billed Medicare, Medicaid and TriCare for nursing services which were substandard and resulted in harm to patients.

The government alleges that the claims for reimbursement were false because GGNSC provided residents with inadequate and worthless monitoring, documentation, and prevention and treatment of wounds.  By failing to provide adequate wound care services to its nursing home residents, Golden Living placed at risk the life and health of individuals who were entrusted to its care.

A representative of the U.S. Department of Health and Human Services said that its Medicare and Medicaid fraud investigators will aggressively investigate nursing home fraud involving allegations of substandard care.  “Quality of care in nursing homes is a top priority for the Office of Inspector General.  Health care providers need to know that if they provide worthless services to those most in need, they will pay the price.”

The substandard care allegations were first raised by Dr. Joseph L. Micca, a medical director at one of the company’s nursing homes.  Dr. Micca started a lawsuit against the company under the qui tam, or whistleblower, provisions of the False Claims Act.  This statute allows a private citizen to bring a lawsuit on behalf of the United States and share in any recovery.

The lawsuit was filed “under seal” (in secret) to allow the government to investigate the allegations before Golden Living knew that it was being sued.

As a reward for helping the government stop fraud and prevent harm to patients, Dr. Micca will receive a share of the settlement payment.  The statute provides for a reward of between 15% and 30% of the amount recovered by the government.

If you are aware that a nursing home or other healthcare provider is submitting Medicare or Medicaid claims for substandard care, treatment that was never provided, or based on false medical records, then you should consult with an experienced False Claims Act attorney immediately.  You may be entitled to legal protections and a substantial reward as a False Claims Act whistleblower.

To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 or click here to reach our offices via email.  No legal fees are charged unless your case is successful.

John Howley, Esq.

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