Vanguard’s Nursing Facilities Earned Big Profits While Providing “Grossly Substandard Care”

The United States filed a False Claims Act (FCA) complaint against six Vanguard nursing facilities and Vanguard’s Director of Operations, Mark Miller. The complaint alleges that the facilities failed to provide the most basic and essential skilled nursing services to their residents, such as administering prescribed medications, providing wound care as ordered by physicians, and managing residents’ pain. The complaint further alleges that Vanguard residents were subjected to unnecessary physical restraints and medically unnecessary and excessive psychotropic medications. As a result, Vanguard residents suffered pressure ulcers, falls, dehydration and malnutrition, among other harms.

In a press release issued by the Department of Justice, Principal Deputy Assistant Attorney General and head of the DOJ’s Civil Division Benjamin C. Mizer said: “Our seniors rely on the Medicare and Medicaid programs to help care for them with dignity and respect. It is critically important that we confront nursing home operators who put their own economic gain over the needs of their residents.  Operators who bill Medicare and Medicaid while failing to provide essential services will be held accountable.” In addition, a U.S. Attorney for the Middle District of Tennessee David Rivera stated: “We are committed to combating elderly abuse, neglect and financial exploitation. We will continue to hold accountable those who profit from the care of elderly Medicare and Medicaid beneficiaries, including nursing home operators, while providing non-existent or grossly substandard care.”

This case illustrates the government’s emphasis on combating health care fraud. The lawsuit was filed under the FCA, which is the government’s primary tool in recovering funds fraudulently obtained from federal programs like Medicare and Medicaid. The FCA is mostly known for its “qui tam” provisions, which allow private citizens, commonly called whistleblowers, to bring suit in the name of the government, and to be paid an award from recovered funds. In 2014 and 2015, the Health Care fraud cases accounted for $4.4 Bn in FCA recoveries.