Dec 162012

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FBI seeks tips about and prosecutes corrupt California public officials

United States Attorney General Eric Holder speaking at a press conference alongside FBI Director Robert Mueller, in the public domain. (Photo credit: U.S. Department of Justice, October 11, 2011)

Justice Department’s Medicare fraud investigation of nursing home chain Life Care Centers of America revealed by unsealed court records

Following a scathing report last month by the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) on nursing home Medicare fraud, a federal judge recently unsealed court records detailing the U.S. government’s four-year investigation of and Medicare fraud lawsuit against a leading nursing home operator.

In response to a petition by attorneys for the Chattanooga Times Free Press, U.S. District Judge Harry S. Mattice Jr. unsealed court records on November 30, 2012, revealing that the U.S. Department of Justice (DOJ) has been conducting a nationwide Medicare fraud investigation of Cleveland, Tennessee-based Life Care Centers of America Inc. (Life Care). According to the court records and the Chattanooga Times Free Press, the DOJ has received assistance from many lawyers, investigators, and officials from the Offices of the United States Attorneys, the commercial litigation branch of the DOJ’s civil division, the HHS-OIG, and the Tennessee Bureau of Investigation.

Two whistleblower Medicare fraud lawsuits prompted DOJ’s investigation of and consolidated False Claims Act lawsuit against Life Care

The DOJ began its investigation in 2008 after two whistleblower employees at Life Care facilities in Tennessee and Florida filed Medicare fraud lawsuits under the federal False Claims Act against the privately owned Life Care, which operates more than 230 nursing homes and assisted living facilities in 28 states across the U.S. According to the unsealed court documents at the U.S. District Court for the Eastern District of Tennessee, Tammie Taylor, a former occupational therapist at Life Care Center at Inverrary, in Lauderhill, Florida, filed a Medicare fraud lawsuit, also known as a qui tam action, against Life Care in the U.S. District Court for the Southern District of Florida on June 25, 2008. In addition, registered nurse Glenda Martin, who is a former staff development coordinator at Life Care Center of Morristown, which does business as The Heritage Center, in Morristown, Tennessee, filed a separate qui tam action against Life Care on October 16, 2008.

The court documents unsealed on November 30, 2012, reveal that Justice Department prosecutors were trying to negotiate a settlement with Life Care from mid-2010 through 2011 to avoid litigation. But after prosecutors were unsuccessful in reaching a settlement, the Justice Department intervened in both qui tam actions against defendant Life Care and filed a consolidated False Claims Act lawsuit against Life Care on November 28, 2012, the court filings say. The DOJ is acting on behalf of the U.S. HHS’ Centers for Medicare and Medicaid Services (CMS), which administers the federal Medicare program, and the U.S. Department of Defense’s Tricare Management Activity, which administers the U.S. military’s health care insurance program (TRICARE).

The government’s prosecution team, which includes DOJ attorneys from the U.S. Attorney’s Office for the Eastern District of Tennessee and other states, are seeking “to recover millions of dollars that Life Care caused the Medicare and TRICARE programs to pay for services that were not covered by the skilled nursing facility benefit, that were not medically reasonable and necessary, and that were not skilled in nature,” according to the DOJ’s lawsuit. “The defendant was unjustly enriched at the expense of the United States, in such amounts, as determined at trial.”

Life Care Centers of America used “systematic scheme” to bilk millions from taxpayer-funded Medicare and TRICARE, says DOJ

The Justice Department’s Medicare fraud lawsuit alleges that Life Care regularly and deliberately bilked the taxpayer-funded Medicare and TRICARE programs out of millions of dollars since at least 2006. Life Care accomplished this, the lawsuit claims, by engaging in a “systematic scheme” to “ramp up” the amount of intensive and more profitable therapy that Life Care provided to Medicare patients. In other words, according to the Justice Department, Life Care had a corporate strategy to maximize the daily minutes and the number of days it billed to Medicare and TRICARE at the “ultrahigh level” of therapy. The ultrahigh level refers to the highest and most profitable of five levels of physical, occupational, or speech therapy used to determine patients’ care and resource needs and, therefore, Medicare and TRICARE payments to nursing homes.

The government alleges in the False Claims Act lawsuit that Life Care Centers of America deliberately carried out its “systematic scheme” to defraud and overcharge the federal Medicare and TRICARE programs by:

  • “Aggressively push[ing] its facilities and therapists to get as many of its Medicare beneficiaries into the Ultra High RUG [resource utilization group] level as possible.”
  • “Setting aggressive Ultra High related targets that were completely unrelated to its beneficiaries’ actual conditions, diagnoses, or needs.”
  • “Reinforc[ing] those targets at corporate meetings and presentations, through regular emails from or visits by corporate personnel, through employee performance evaluations.”
  • “Imposing action plans on underperforming facilities.”
  • “Punish[ing] those facilities and employees that failed to meet its Ultra High targets or that complained about corporate pressure.”
  • “Reward[ing] and applaud[ing] those that met its targets.”
  • “Frequently overr[iding] or ignor[ing] the recommendations of its own therapists and unnecessarily delay[ing] discharging beneficiaries from its facilities.”
  • “Pressur[ing] its facilities and therapists to extend their Medicare beneficiaries’ stays in Life Care facilities to maximize Medicare revenue.”
  • “Provid[ing] excessive amounts of therapy that were not medically reasonable or necessary.”
  • “Provid[ing] services that did not qualify as skilled rehabilitation therapy simply to meet the ever-increasing demands of higher Ultra High targets.”

As a result of Life Care’s “systematic scheme” and “corporate pressure to maximize its Ultra High billings,” Life Care rehabilitation therapists “provided Medicare and TRICARE beneficiaries with excessive amounts of therapy that was not medically reasonable and necessary, and sometimes even harmful,” the government’s lawsuit says. “Instead of providing skilled rehabilitation therapy that was tailored to beneficiaries’ particular needs, Life Care therapists routinely provided generic, nonindividualized services that did not (and could not) benefit the beneficiaries and that served primarily to inflate what Life Care billed Medicare and TRICARE for those beneficiaries.”

Life Care’s “systematic scheme” and constant corporate pressure on rehabilitation therapists to “upcode” increased Medicare payments, says DOJ

According to the Justice Department, Life Care’s “systematic scheme” and corporate pressure on Life Care rehabilitation therapists to “upcode,” i.e., fraudulently bill Medicare and TRICARE for higher and more profitable levels of therapy that patients’ care and resource needs did not justify, were successful. “By 2008, for example, Life Care billed nearly 68 percent of its Medicare rehabilitation days at the Ultra High level—a level far in excess of the nationwide Ultra High average of 35 percent among all skilled nursing facilities during that same year,” the DOJ lawsuit says. “Life Care’s corporate strategy and pressure succeeded in . . . inflating the money it received from Medicare and TRICARE.”

The lawsuit provides many examples to show that Life Care rehabilitation therapists, who the DOJ alleges were constantly pressured to “upcode” and “ramp up” billable therapy minutes, regularly provided, and Life Care billed Medicare for, ultrahigh therapy that Life Care knew was “medically unreasonable, unnecessary, and unskilled.” According to the DOJ, Life Care therapists also inappropriately provided, and Life Care billed for, ultrahigh therapy that “sometimes jeopardized the health of Medicare patients who were imminently terminal, fatigued, sick, or otherwise medically unstable.” For example, the government’s complaint states:

Patient D was a 92-year-old resident of Life Care of Orlando in Florida who was dying of metastatic cancer (melanoma) that had spread to his brain and lungs. Patient D had received palliative radiation therapy and was becoming weaker and more medically fragile after that treatment. Nevertheless, Life Care therapists recorded at least two hours a day of therapy in all three disciplines at the Ultra High level for Patient D from July 24, 2007, until his death on August 8, 2007. Two days before Patient D’s death, he was spitting out blood. Life Care therapists, however, still recorded 48 minutes of physical therapy, 47 minutes of occupational therapy, and 30 minutes of speech therapy that very day. The day Patient D died, Life Care therapists recorded 35 minutes of physical therapy and had him scheduled for occupational therapy later in the day.

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  56 Responses to “Nursing Home Chain Life Care Bilked Medicare of Millions, DOJ Suit Says”


    I love this story because it tells it like it is. There should be criminal charges also. The public needs to send a message this will not be tolerated. Our aged and frail elderly people should not suffer abuse to make the rich richer. They should be cared for as human beings and not a $$$ sign. This is beyond belief when these large corporations can actually get by with this type of actions and abuse to our loved ones. These are the weakest of the population and we will be there one day. How can we allow these little helpless patients to be used and abused. Some appeared to be in the dying stage. They needed peace, quiet, comfort and pain control. This is totally unacceptable!!!!


      i spent 3 weeks in lifecare. the article hits the nail on the head. each facility has a financial executive and those are the lifecare executives who put the pressure on the physical therapists to commit medicare fraud. each and every one of them should be convicted of medicare fraud. lifecare has a lot of political power in the towns that they are located in and the executives are an arrogant, criminal lot. america is becoming a failed state because of these crooks.


        Lifecare took our home, and we are homeless. My animals were also taken and are in the local pound. They had our home seized, those creeps!!!! To think, a billion-dollar company that took my only inheritance on a default. My mother was too ill to attend the court hearing.

        Lifecare won its most likely (only case) against my mother, by default, who went to a Lifecare facility after knee surgery for rehab. The plan was she would get rehab and return to her home and enjoy her life. She drove and did many other things she enjoyed.

        This is not what happened. My mother got about maybe 2 weeks of rehab, and then the therapist came to my mother and told her she was leaving and getting a job elsewhere. She said she did not like what was going on behind the scene at Lifecare. Who knew it was ripping Medicare off and more?

        My mother never got a new therapist, but instead was told they were “short handed.” I was told myself the same thing with a promise she would get the therapy at some point. In the meantime, she was left in a wheelchair, fed, washed, and entertained with music and art. My mother was outraged, and so was I.

        She was 79, but a young 79. She was fully aware of everything and wanted help to walk. Months went by with promises of “help is on its way “but never came to her.”

        I at some point received a phone call from the head guy of the facility she was in. He asked me to approve moving my mother to the “permanent side” because he needed the beds for two men. I said, “No, absolutely not.” The next day, when I was going to visit my mother, I found two men in her room. I asked an aide where my mother went to, and she pointed to the “permanent section.” My mother told me she was moved at midnight against her will. They pushed her in a wheelchair to the other side being told she would still get therapy. But she never did.

        After nearly a year’s stay, catching MRSA and then cellulitis and being hospitalized for both, she never got the needed care. I took my mother home. She no longer could move her legs, and they remained bent in a sitting position. We had lots of changes to make to accommodate the wheelchair, and she got therapy at home. We still tried to get her to walk, but it was too late. Her knees were stuck in the bent position they were in.

        I was heart broken to say the least to watch my mother suffer so much due to the ignorance of Lifecare’s hands. When I took her out, she was handed a bill for Lifecare $21,000.00 and a bill for the state $40,000.00. We were shocked since my mother was very insured. What a nightmare!!!!!!!


        So, in your uneducated mind with “3 weeks” of employment with LCCA, you can come to the conclusion that ALL the executive directors of LCCA are a “criminal lot”? What stupidity! I worked for LCCA for several years, and not once did I ever break any laws, pressure anyone to violate any state, local or federal regulation nor law, and I have been an investigator, surveyor and a devout and dedicated Christian who does not commit crimes!

        You are a slanderer, liar and someone who could only work for “3 weeks.” Hmmm, wonder what you were let go for?


    It’s all true! I know I use to work there and watched it happen many times. The pressure was unreal! They shouldn’t be allowed to have a Medicare license anymore.


    True, true, true. In the facility where I worked, increasing therapy minutes was the primary focus in the daily morning interdisciplinary meeting. Pressure was subtle but very real. I felt as if I was working in a factory not a SNF. Shame, shame, shame. Criminal if you ask me.


    The “pressure” is far from subtle…and you will be reprimanded indeed. Since this story broke, the sad part is the pressure and expectations have only become more unbearable, and the arrogance and attitudes worse than ever from upper management and the corporate office. Instead of emails you just get nasty phone calls and more unrealistic expectations.


      Agreed! My mom’s position was threatened multiple times by her superiors to have her department’s RUG numbers match what they wanted. They fired her and her therapists when they refused to start treating patients who were terminally ill and were placed at Life Care for “comfort” reasons only.


    Mr. Preston is listed in Tennessee’s most wealthy at number 8 with over 800 million dollars. Compliments of staffing at or below individual state minimum levels and fraudulent billing practices. Millions made from tax based systems, but hey, he gets a new jet.


    Why pick on Life Care Centers when this is the “industry norm”?


      Why “pick” on them? … Tell that to the Justice Dept. And if you read, you will see a lot of these comments are being based on employees or former employees that know the situation. And it is the voice of these people that save our govt. billions of dollars! Pick away writers! Stop these fools and this father/son scam!!!


      Is this really the “industry norm,” as you say anonymous? Well, it is true that allegations of Medicare upcoding and major Medicare fraud have been made against other U.S. nursing home chains.

      Please read our November 29, 2012 blog article “Nursing Home Medicare Fraud $1.5B a Year, Says New U.S. HHS-OIG Report.” In the article, we refer to the March 29, 2010 Washington Post article “Review Heightens Concerns over Medicare Billing” by Scott Higham and Dan Keating. The Washington Post article said that “a separate division” of the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) was investigating Dana Point, California-based North American Health Care, Inc. (NAHC), which operates 35 facilities.

      According to the Post, Service Employees International Union (SEIU), which had been in a union-organizing dispute with NAHC, discovered a “pattern” of Medicare “upcoding” by NAHC. “The SEIU gave results of its NAHC examination to Rep. Pete Stark (D-Calif.), who chairs a House Ways and Means subcommittee that oversees Medicare,” said the Post. “In September, Stark asked the HHS inspector general to investigate, alleging that NAHC ‘may have overbilled Medicare more than $180 million through a system-wide pattern of ‘upcoding.’’”

      In our November 29, 2012 blog article, you can read more about what the Washington Post’s own analysis of SEIU data on North American Health Care’s Medicare billing found. You can also read the response to the “upcoding” allegations in the Washington Post by John L. Sorensen, North American Health Care’s president and chief executive.


      It is the industry norm. I worked at two Life Care facilities and have worked at over a dozen other nursing home facilities. What Life Care did is nothing that others are not doing as well. Therapists in nursing homes are threatened with their jobs if they do not comply. They have no recourse and nowhere to turn. Their licensing boards simply say, “You cannot do that, and if you do, we will get you.” Their professional associations do nothing either. They have no unions and no say.


      The reason Lifecare is a target is because they take the industry-wide abuse methods to a whole new level.

      If you read the report, their average of RUG patients is almost twice the industry standard.

      Patient rights have gone out the window.


    My husband was a patient for several months at East Ridge Care Center of America. When he was first admitted, they refused to try to help him stand up because they said pain was too bad. Pain was bad, but I have had numerous health care professionals tell me if he had been on his feet sooner, he would more than likely have been able to recover completely. They would schedule him for all types of physical therapy and wheel him down the hall, where he would sit in his wheelchair for hours, until his hands and feet were icy cold. Eventually, they would wheel him back to the room, and it would take two employees to put him back to bed. I had to seek personal medical assistance to get him to hospital, where he was diagnosed with dementia, staff infection, among other things probably caused by inefficient care. No one at the Center would help. He also received abusive handling by a staff member who basically tied his feet together with a sheet and literally threw him back into the bed. I didn’t know where to turn to for help. Something drastic needs to be done to these people!


    I worked as a charge nurse for this company. Everything in this article is true, and the JD needs to open up the books at all Life Care facilities. I was forced to do Medicare charting on residents because of physical therapy orders that were so demented that they could not even follow basic commands or feed themselves. I charted on hospice patients who still got therapy who were so frail they could not perform, and if you balked, you were told to do it or there’s the door. I watched as the DNS and RCM along with physical therapists sent out physical therapy orders that were “robo signed” by docs who never came in and evaluated the patient. They staff according to census which is their holy grail, not acuity. Thus most nights, I had 42 patients with 4-5 CNAs under my supervision. You never could do more than put out fires. They are profit driven only, and their management style is like a dictatorship. I am gone now and do miss my patients but hope that this company meets its demise.


      I agree 100% with everything that you said. I was in Lifecare facility and there is an evil, corrupt vibe in that place, and the doctors who robo sign the physical therapy orders are crooks as well. Did you know that they charge 18% interest on any unpaid bill? A disgusting company run by thugs and crooks.


      Kudos to you ladies for speaking out! … We all need to do a walkout, and let these fools figure it out!


      Retired nurse, you are so right! I have worked as a CNA in a Life Care facility for over 10 years now. I have heard nurses complain of being told by management on what to put in their Medicare charting and if they don’t do as they are told, they are put on the “hit list,” as they call it, to be the next one fired. We are working short all the time, 4 CNAs for almost 70 residents on day and evening shift, only 2 CNAs for those residents on night shift! Management is always talking about the budget. That’s all this company is about is the money. They don’t care about the residents or employees. It’s a shame that they have reduced our yearly raises to 1%, and you’re lucky if you get your annual evaluation on time. You wouldn’t believe the shady things the management has done and told to do by corporate. So many cover-ups in charts before state comes in for their yearly survey. The last few years we were all surprised we actually passed state survey when they came back to follow up on all the tags. It makes you think they were paid by someone. The facility has a lot of great nurses and CNAs that truly love and care for our residents. It’s a shame that the corporation we work for doesn’t. They only see them as dollar signs and not human beings.


    Fraud is never ok, and yes those at the top do seem to get richer. But let’s look at a facility’s individual costs. This issue was 7 years ago and should be addressed if true. Now real time people the cuts to Medicaid and Medicare are not just affecting bad nursing homes, but the good ones. Yes, there are good ones with caring staff and doctors. (Did I mention that many doctors are getting out of the elder business because they are losing money?) As hard as it is at times to understand, this industry is a business. How long would you be in business if you never made money? This is not an endorsement of Life Care. If they did it, they did it. But people, we are an aging population, and although many of you may say you will care for your loved one at home, many of you won’t. Many of you have tried. It is the hardest job you never get paid for, and many of you, thank God, have never had to make this choice. There is a need. Think about it.


      Anonymous, you have no idea what is going on and have not seen what this company is doing to helpless, frail human lives. They have destroyed and abused the elderly and their families. All in the name of despicable greed. My mother’s life has been forever changed because of neglect and pure laziness. These people need to be put in prison. No one is saying they should not make money, but not at the expense of the sick, elderly. And not stealing money from our loved ones. You truly are an idiot!!!


    I work at Life Care now 5 years. I admitted her because of the good care, but at her age in 80s, I did not like it when they took her by wheelchair to therapy. She would not want to go through the door in therapy room. I was asked to talk her into the gym by the therapist, and I felt if she did not want to go, leave her alone. But now with the legal action of the U.S.
    Attorney, I feel I want to tell to Life Care attorneys and settle out of court. Please contact me Life Care if you read this. Joseph M. 816-739-5656. It’s a matter of your resident abuse and respect.


    Totally agree! This is every single nursing home in the United States. If you are a therapy company that does not go along with what the customer wants, you will be eliminated, and another therapy company will come in. I worked for Genesis Rehabilitation Services. They constantly encouraged therapists to overbill. One of their main managers, Neil T. of New Hampshire, sent a letter to the people he supervised bragging about how certain facilities were doing such a great job because their ultra-high percentages were attracting letters from Medicare. With arrogant idiots like this in charge, what do you expect? Try to do the right thing, and you are gone.


      Most contract rehab services ARE crap. Don’t go to any facility that tells you they do not hire and have their own therapy department in-house. They are not vested in the best interest of the building or the residents they are coming to help. They do not provide consistently the same staff, don’t bother learning a contract therapists name, and won’t be back the next day!


      The only arrogant idiot I see is you! Based on your unprofessional letter, I don’t see you being employed by anyone much longer. I certainly would not want you to be anywhere near my mother to give therapy. My mother is in a good ethical nursing home. Your “everything is bad” makes me sick. You must be a therapist for money because you certainly do not present as someone who should work with vulnerable people.


    This happens everyday all day…Wake up and smell the dark roast!!!! Healthcare is so fraudulent. I hope I never need short- or long-term care…It’s all about the money, and they pay their employees crap wages.


    Staff should be free to make decisions that are based on need and not payer source. It would be refreshing to come into work and just provide what patients need. Usually if one does this, it will all work out in the end. Life Care Centers often punish employees that insist on doing things ethically with no profit in mind. Now there are penalties for transporting patients back to the hospital. There could be some wrongful death lawsuits if the families only knew. Administrators are trying to impact decision making that should only be made by the direct care staff. Directors often try to hush the employees with fear tactics, neglect of chain of command, and poor performance reviews, and make claims that the intent was not there and that you have misunderstood them. Employees are not paid enough to quit their jobs. Staff are overworked and underpaid. When complaints of staffing ratios are voiced, the company has been unwilling to do the right thing. Management will ask for employees to respond to incidents with reports and screenings yet provide no education to staff to assist in helping the situation. Often decisions are made without input from the direct care staff employees and by employees that have little or no direct care staff experience. This company will tell centers who has called to complain at the corporate office. The directors will tell the employees that “this may not be the right fit for you” when you bring up a concern that involves money that will help solve it. What do you do when you need your job but also have standards of care? You can advocate for patients and inform them of their rights. But how much is really reported and documented?


      I don’t think much is reported and documented. The Life Care facility that I currently work in is so worried about census and budgets. Management will do and say anything to keep a nurse from sending a resident to the hospital, even if it is medically necessary, if census is low! It’s a damn shame the way they run this corporation!!


    As a former nursing management employee at a Florida Life Care Center, I, and the other nurses on my unit, witnessed a complete dismissal of the Christian ethic expounded by the LCCA mission statement. Even though we remained in the long-term care business, the lure of the Medicare rehab dollar was too strong. Greed was such a huge factor that it wasn’t even a hidden sin. Upper management openly joked about such things and eventually changed the climate of care from one of compassion for the residents to one of blatant disregard for issues not related to rehab and the cash it provides.

    During a big remodel of the facility a couple years back, several of us fought for a day room where our long-term patients could spend time while up from bed, to afford a small amount of life quality. I personally lobbied throughout the planning and construction to make sure they were not left out. The executive director kept me at bay by insisting that this would be done, even though he was unable to disclose the details. Suddenly all discussion ended when he announced that a bistro would be built instead of a place for the long-term residents, so as to better compete for the rehab dollar with a more attractive and marketable facility.

    To this day, long-term residents are lined up along the wall around the nurses station, clogging the hallway and allowing for nothing of life quality except supervision. This is the very same place where paper products are routinely deposited by delivery drivers. A typical configuration would be resident, resident, resident, pallet, resident, pallet. At times they would share the space all day. No activities for lower-functioning residents were even attempted.

    Activity notes usually reflected refusals of activity opportunities, even when clearly inappropriate. Much of what we did was to present an illusion of quality of life, when we really had no ability to provide one. Over time employees became used to providing care at this level and also became proficient at damage control. Our long-term staff did whatever we could to keep the pressure on administration to improve conditions, but eventually the lip service we received made our efforts seem fruitless.

    When this federal lawsuit was announced and the statistics about high RUG levels were revealed, I asked our MDS coordinator if our facility were high. He stated that we were closer to 100 percent ultras. Even the threat of impending exposure didn’t slow them down. Greed is a powerful force.

    We had many examples of unnecessary therapy, but a couple of situations stand out as embarrassingly blatant. Many long-term patients were picked up by the therapies for functional decline under Medicare B. These were outwardly noble efforts, but rarely did any of these residents have improvement. Frequently they would sit in the therapy gym with a cup of coffee to watch the others getting their rehab. Ironically we liked it from a nursing standpoint because this did meet an activity need for a while. Since there was so little for them to do, many residents and families would request therapy solely for the activity value. Thanks Medicare.

    There were many examples of therapy provided and charged for to residents who derived little value for the Medicare dollar spent, but the one that many of us will always remember was a 90+-year-old woman with only a remote niece as a power of attorney. She refused to eat, and despite our attempts to encourage her, she always refused and openly and consistently stated her resolve to die. When our efforts became obviously fruitless, we had a telephone conference with the niece, who made the decision based on our recommendation to refer her to hospice so that her care could now reflect her wishes to die comfortably and with dignity. The physician agreed, and the niece agreed that these were her wishes and that these wishes and comfort and freedom from pain were the most important issues.

    Several days after hospice was instituted, we heard that our Medicare census was down a little, so all of the long-term residents would be screened for possible therapy again, not for resident-based needs but for bottom-line reasons. The executive director took it upon himself, without consulting either the physician nor the nursing staff, to call the niece and recommend that this lady be taken back to therapy for further rehabilitation. I can still remember her screaming at the staff to leave her alone because she wanted to die. Life Care was able to squeeze out a few more five-hundred-dollar days of therapy at her bedside. She wouldn’t even drink their coffee. She died pretty much as expected though she was pestered until just a few days before her death. Our perceived role on that unit was to be a patient advocate, and I fear for the residents now that I can no longer fight for them.


    I was a resident of a Life Care facility for a few months back in 2008-2009 after having fractured an ankle very badly. I have a plate and ten screws in that ankle. At the age of 75, post hip replacement, post stroke, having 3 feet of colon removed, diabetic, etc., they did not give up on me. Fortunately, I have had no mental depletion because of the above. By golly, folks, their rehab was top notch. They worked on me and pushed me to strengthen me from the ankle up, especially on the hip which had NOT been properly worked on when it was replaced. They were appalled that I had been neglected during that recovery the year before the ankle fracture.

    ANYWAY, no matter how the resident is treated, good or bad, there is money to be made. But what are we gonna do? They could have let me waste away in bed, and I would have ended up in permanent custodial care until death!

    I guess THAT would have been cheaper, huh?

    I get it that some folks can’t benefit from a lot of rehab. I get it that it is expensive. So, you people out there who want to fix this, sign a contract/agreement that you personally insist on passing up on rehab if you end up in such a center . . . with an ailment that could be improved. Yes! Be nice and let the rest of us be helped.

    On the other hand, maybe I am the ONLY one they ever helped?

    By the way, I was never, never neglected there. I was nosy and curious and interested on all that was going on. The center I was in kept every resident as busy as possible every day with chair exercises, music, and so much more.

    If you put this business OUT of business, well, nothing more I can say.


      They would not have made as much money if you were a “custodial” patient. Thank goodness you appear to have received medically necessary therapy of sufficient intensity to affect functional changes and a good discharge disposition. If this were the rule and not the exception…


    I work at a Life Care Center, and much of what I have seen above is true. Even the activities dept. writes notes that have false statements in them. Nursing is stressed to the max because of poor staffing and increased acuity. As has been said before, low staffing is the norm in nursing homes, not just Lifecare. As bad as our facility is, there are much worse in our city. This is why medical care should not be a for-profit industry. It all makes me so sad.


    Sorry, but I almost think saying Life Care is the only one that should be named here is wrong. I work for RehabCare, and after reading the details of the recent lawsuit in Massachusetts, I actually thought they could be talking about where I work. We aren’t allowed to discharge patients. Our program manager changes our billing codes to max reimbursements. We have to be 90% productive, and treating terminal patients is not unusual.

    However, we need a job, and yes, we will be fired if we have not been able to get out minutes only to have them doubled the next day since they are calculated daily. Plan of care is that we treat as many times a week as it takes to get those minutes. It’s awful. It’s not what is best.

    Some patients are too sick to tolerate it, and some don’t need it. And I am sorry a psych admission doesn’t mean they should return an ultra-high.

    But personally, I have filled out online the fraud forms, but we don’t even get reviewed. So, until they change the PPS system and eliminate the times therapy as they have it now, it will continue.


    I worked at a Lifecare as a nurse. I was in the role of evening supervisor when all the admissions come in and staffing is lower than day shift. I was mostly dealing with managers who wouldn’t listen or were not adept at keeping their staff in line and ignoring us when we complained about short staffing.

    We would frequently miss breaks and meal times because it was not safe to leave patients. The working conditions and patient safety concerns were so stressful.

    When I told my DON and executive director about this, I was treated so badly and as if I was incompetent. I was demoted from my management status, and the DON and executive director didn’t look at me in the face for years.

    This company is all about the money. They are a trained corporate team bent on the bottom line. Patient safety and comfort are only an imperative for advertising, and that comes from overwork of their staff under the company motto “whatever it takes.”


    I worked at Life Care for 10 years, and the federal lawsuit was definitely justified. I have seen residents dragged out of bed for ST, OT, and PT within days of dying. Nurses are encouraged to exaggerate a resident’s condition in the charting. The wing supervisor would type out what he wanted the nurses to chart on a specific resident in order to get more money from Medicare.

    Life Care has many good and honest employees, but the dishonest management needs to go.


    Life Care is guilty. It is the worst company to work for and only wants people in management to be puppets. Thank God I was able to get out of this dysfunctional company only lead by operations. The lawsuit may point at rehab, but in truth it is Forest and Bart that is mandating the push for therapy to bill Medicare for more dollars. Bart Walker is the worst Sr VP in the company that only has dollar signs in his vision NOT appropriate care.


    Guilty. Hope OIG wins case and shows Forrest he is not above the law.


    I would like to know what is going on with the suit against Life Care and if it will just get paid off and be swept under the rug like so many.


    Life Care refuses to accept that an elderly resident is in end of life. Refuses to let her rest and have comfort care. Thinks they know better than hospice and provides no services to families. My 90-year-old mom is trapped there.


    Everything in this lawsuit is true.

    I have worked for Life Care Centers for over a year, and the pressure of getting Medicare patients is to the extreme. Being in admissions the only thing the administrator, regional marketer, divisional VP and regional VP cared about was Medicare census. They consistently say they do not care about patients with the HMO insurance because those are monitored by the insurance company. Medicare is it. All the admissions and marketing team have to come up with a plan to get the Medicare census up, and if not, good chance you will no longer work there.

    This is happening in California. It is a sad situation. They are far from a Christian-based company they claim.


    It is very sad but true…every allegation of the lawsuit is merited. To those that oppose that position likely have never worked for the company. I believed I was at a reasonably good SNF based on staff retention and patient centered care given by the great nursing staff and rehab team. But the reality is that this article is completely true and it was hard to swallow. I actually got terminated for being the “sole” reason for them not meeting an Ultra High category. This patient was of sound mind and set in her ways and was a frequent admission due to the proximity of her family for visitation as their options were limited. This was my second time working with the patient and she did NOT want therapy…at least not from my discipline. I will not divulge that due to fear of repercussions from the Life Care upper management. This is only one patient in a long list that I was pressured to provide unwarranted and ineffective therapy for during my time in the facility. This particular patient barely participated in the evaluation and stated that she did not want to participate…and this was across all three disciplines. It was brought to the rehab manager’s attention upon evaluation and we were all told she was there for skilled rehab so we had to “find a way” to “get the assigned minutes completed regardless of any ‘barriers’ we came across. Myself and the other therapist working with the patient voiced the same concern but management would not listen to anything we said in terms of the patients choices as well as the families wishes. We, as trained and skilled therapists were stripped of our ethical autonomy that we took our Oath to t is very sad but true…every allegation of the lawsuit is merited. To those that oppose that position likely have never worked for the company. I believed I was at a reasonably good SNF based on staff retention and patient centered care given by the great nursing staff and rehab team. But the reality is that this article is completely true and it was hard to swallow. I actually got terminated for being the “sole” reason for them not meeting an Ultra High category. This patient was of sound mind and set in her ways and was a frequent admission due to the proximity of her family for visitation as their options were limited. This was my second time working with the patient and she did NOT want therapy…at least not from my discipline. I will not divulge that due to fear of repercussions from the Life Care upper management. This is only one patient in a long list that I was pressured to provide unwarranted and ineffective therapy for during my time in the facility. This particular patient barely participated in the evaluation and stated that she did not want to participate…and this was across all three disciplines. It was brought to the rehab manager’s attention upon evaluation and we were all told she was there for skilled rehab so we had to “find a way” to “get the assigned minutes completed regardless of any ‘barriers’ we came across. Myself and the other therapist working with the patient voiced the same concern but management would not listen to anything we said in terms of the patients choices as well as the families wishes. We, as trained and skilled therapists were stripped of our ethical autonomy that we took our Oath to provide only necessary and reasonable treatments due to managerial pressuring and meetings encouraging using ‘modalities’ to increase the number of billable minutes. In turn for each modality ordered and completed we were rewarded with a paid lunch break.


    Life Care Centers no matter where you are are this way. I have worked for many facilities and had family members in different ones as well. Life Care Centers, especially in Washington state, are the worst, keeping people who they make feel like they have nowhere else to go or don’t remember any better. Most should be in AFH, being able to live their life in a more functional way. Don’t forget the ones coming in on hospice, being drug out of bed for “therapy.” What happened to dignity? Or running two halls of about 70 heavy care residents with 3 aides? What kind of care is that?! There is so much more to be said that is wrong, but if the state continually comes in and says no findings, how will it ever get fixed? Life Care is all about the facade, not the truth.


    I hate to read this kind of bashing of so many dedicated and caring people who work long and hard to care for others. Others that most people in our society would never feed, bathe, nor tend day and night. Our elderly have become inconvenient burdens for the new generations, and that is why they are in homes and care centers in the first place. Then when something goes a way “we” do not like nor understand, “we” complain about it. Always knowing, “we” would never take them home and care for them ourselves, for that would cramp our lifestyles and burden our budgets.

    Having said that, my mom was in a very good Life Care facility that had very high-quality management, rehab and nursing staff. The E.D. was a very compassionate man who constantly walked his building and spoke with everyone. He took complaints personally and had things improved quickly, but one day, the company decided he was not their type. The company RVP and HR made false accusations that they could never prove, and that is how they fired several quality people from this company.

    Anyone who truly attempted to do a good, legal and right job was soundly driven out. Now, that facility my mom was in has become a snake pit of liars, adultery, poor care, short staffing and constant harm to residents. Recently, one resident actually died from a lack of care.

    It is sad to watch such a good group of people be completely driven off and a happy, caring health facility become such a place of darkness and curse. No one wants to ever be admitted there, and they have become so bad, the company was forced to cease admissions. Maybe this is best for the safety of the community, and if it does not greatly improve, maybe it should be closed.


    I have been a physical therapist for 27 years. I recall a time when clinicians made ethical decisions regarding what was appropriate for patients to receive timewise and treatment wise for therapy. When reimbursement changes occurred based on minutes for Medicare, therapy management companies began “milking” the system. No longer are clinicians allowed to make decisions based on sound clinical practice. It’s morally and ethically wrong what is happening in SNFs and time for therapists to stand in unity against the corporations driving decisions based on their profit margin.


      Yes!!! All the professional medical community! Lori RN


        Heard through the grapevine…the Department of Justice is doing a great job investigating and preparing to prosecute this case. 100 plus witnesses will be deposed. Now Manorcare is going through the same thing. If we all only had the courage to do what these whistleblowers have done (a nurse, 2 occupational therapists, and a physical therapist), then maybe it would stop! Hope the therapy managers go to jail and lose their licenses!! It all comes down to greed!


      I agree. It’s a sad state of affairs in this company. They dropped all of their VA contracts last year because of government oversight that enforced fair hiring practices. It proved too much for them, and they literally dumped the veterans into the community without more than a months notice. It is far from a Christian environment. They portray themselves in that light, but the actions and behavior by senior leaders are far from it. And yet Forrest Preston gets richer by the year.


    A few years back, Life Care Center of Chattanooga was providing such poor care and received so many tags on its state survey. The state basically shut it down, and all the patients were sent elsewhere, some 200 of them. What I fail to understand is why the state/feds did not file criminal charges against the administrator and Forrest Preston and ban them from the Medicare system for life. A missed opportunity for sure.


    Congratulations to the whistleblowers, Tammy Taylor, OTR (Lifecare), and Christine Ribik, OTR (Manorcare ), 2 OTs who were brave enough to take a risk and had the working moral compass to do the right thing. OTs should be proud!


    If Lifecare does not lose, then they have managed to bribe their way out. Period. The suit is 100% true. The rehab managers put tremendous pressure on therapists, and FORCE them to milk the system. Say something and they simply switch therapists. (Medicare) patients are kept on “rehab” for far too long, doing the silliest nonsense, so that Forrest (good grief) can line his pockets. HMO patients? Bu bye! Mind you, this continues even AFTER the suit was brought forward! There is no way Lifecare wins this. None.


    Who is president of Life Care? And what is he doing about all this?


    Currently have a relative at a LC facility. Definitely still some funny stuff going on in billing. I noticed this before I started researching. As for the “care”…If you can’t/don’t closely monitor your loved one, you will regret it! They are going to get away with what they can. Understaffing + laziness + lack of empathy is prevalent! I know from experience that reporting anything is practically useless. Between DSHS, APS, and any related agencies. No one really wants to rock the boat. They’ve all got each other’s backs.






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