The United States has filed a False Claims Act case against Vanguard Healthcare LLC, Vanguard Healthcare Services LLC, Boulevard Terrace LLC, Vanguard of Crestview LLC, Glen Oaks LLC, Imperial Gardens Healthcare and Rehabilitation LLC, Vanguard of Memphis LLC, Vanguard of Manchester LLC and Vanguard’s Director of Operations, Mark Miller, the Department of Justice announced today. The lawsuit alleges that the defendants were responsible for the submission of false claims to Medicare and Medicaid for skilled nursing home services that were either non-existent or grossly substandard. The lawsuit also alleges that the defendants submitted required nursing facility Pre-Admission forms with forged physician and nurse signatures. Vanguard Healthcare LLC is headquartered in Brentwood, Tennessee, and has 14 long-term care nursing home providers operating around the United States.

“Our seniors rely on the Medicare and Medicaid programs to help care for them with dignity and respect,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Department of Justice's Civil Division. “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.”

The United States’ complaint alleges that between Jan. 1, 2010, and Dec. 31, 2015, the six Vanguard facilities failed to provide the most basic and essential skilled nursing services to their residents. The lack of adequate care at the Vanguard facilities included chronic staffing and critical medical supplies shortages, failure to provide standard infection control, failure to administer medication to residents as prescribed by their physicians, failure to provide wound care as ordered by physicians, failure to adequately manage residents’ pain and providing unnecessary and excessive psychotropic medications to residents and using unnecessary physical restraints on residents. As a result, Vanguard residents suffered pressure ulcers, falls, dehydration and malnutrition, among other harms. The United States’ complaint further alleges that Miller, who served as the Director of Operations for Vanguard from September 2011 through August 2014, knew that resident care at the Vanguard facilities was non-existent or grossly substandard but failed to correct these problems.

The United States’ Complaint also alleges that from September 2012 through April 2014, Boulevard Terrace LLC, Glen Oaks LLC, Vanguard of Memphis LLC and Vanguard of Manchester LLC fraudulently submitted falsified Pre-Admission forms to Tennessee Medicaid.

On May 6, the Vanguard corporate entities named in the government's complaint filed voluntary petitions for relief under Chapter 11 of the Bankruptcy Code, which were administratively consolidated in the Middle District of Tennessee.

“We are committed to combating elderly abuse, neglect and financial exploitation,” said U.S. Attorney David Rivera for the Middle District of Tennessee. “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 and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $30.6 billion through False Claims Act cases, with more than $18.5 billion of that amount recovered in cases involving fraud against federal health care programs. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement, including the conduct described in the United States’ complaint, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).

This matter was investigated by the Commercial Litigation Branch of the Justice

Department’s Civil Division, the U.S. Attorney’s Office for Middle District of Tennessee, the Department of Health and Human Services’ Office of Inspector General, and the Tennessee Attorney General’s Office and the Tennessee Bureau of Investigation Medicaid Fraud Control Unit. This action is supported by the Elder Justice and Nursing Home Initiative, which coordinates the department’s activities combating elder abuse, neglect and financial exploitation, especially as they impact beneficiaries of Medicare, Medicaid and other federal health care programs. For more information about the Department’s Elder Justice Initiative, see https://www.justice.gov/elderjustice/.

The claims asserted against the defendants are allegations only and there has been no determination of liability.

The lawsuit is captioned United States vs. Vanguard, et al., CA 3:16 -cv-02380 (M.D.Tenn 2016).