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Tennessee Nursing Home Residents and Patients Suffer Neglect Due to Fraudulent Billing for Non-Existent Care

When we entrust our parents, grandparents, or others into the care of nursing and rehabilitation facilities, we expect that they will receive the care and attention they have been promised. When that care is not provided but is still being billed, the losers are numerous – the patients, the insurance companies, and taxpayers who support the government agencies paying the facility. The Tennessean recently reported that the Vanguard Healthcare, LLC, out of Brentwood, Tennessee, is being sued by the federal government for doing exactly this: submitting bills and accepting payment for care and supplies that were never provided to Vanguard’s patients and residents.

As a result of an investigation into the billing and claims submitted to TennCare and Medicare by Vanguard Healthcare, LLC, the US Attorney’s Office for the Middle District of Tennessee has filed suit against Vanguard in federal court, alleging Medicare and Medicaid fraud.  According to the Tennessean, rehabilitation facilities and nursing homes in Middle Tennessee, owned by Vanguard, were found to have submitted bills and claims for care that it never provided to its residents and patients. Investigators found that not only were wound and pain care not being provided to residents as billed, in many cases the basic needs of patients – such as administration of medication and control of infection – were not being provided.

The government’s investigation found that skilled care and adequate staff were not being provided to residents, although claims and billing for such were submitted by Vanguard to TennCare (Tennessee’s implementation of Medicaid) and Medicare.  Some of the nursing home residents suffered pressure sores, dehydration, malnutrition, and falls due to the inadequate staffing, lack of care, and shortage of medical supplies. A dying patient was discovered in obvious pain, having been denied the very pain medication that his family had previously deposited for him at the facility.

While there are laws in place to protect the government and insurance companies from fraudulent and false billing by nursing home and rehabilitation facilities like Vanguard Healthcare, LLC, there are also laws in place to compensate those residents and patients who are harmed by the resulting abuse and neglect suffered at such facilities. There are civil remedies for the individual residents and patients of Vanguard’s Middle Tennessee nursing homes and rehabilitation centers who suffered from pressure sores, soiled bedding, infections, untreated pain, and falls due to lack of assistance.

Pursuant to Tennessee law, particularly according to the Tennessee Adult Protection Act, individuals who are victims of nursing home neglect, abuse, or fraud can be compensated for their damages. The fact that the federal government is prosecuting Vanguard for fraud in its billing practices will not preclude the residents and patients of Vanguard’s facilities from the filing their own lawsuits, seeking compensation for their own particular and personal damages suffered due to Vanguard’s failure to provide basic and necessary services. Those who were denied clean beds and surroundings and as a result suffered infections, and those who were not properly given their prescribed medication and thus needlessly suffered in pain have individual rights to compensation by the nursing home that failed to provide the services and supplies for which they submitted claims, beyond the damages that the government is seeking.

In a 2009 Tennessee case, Smartt v. NHC HealthCare/McMinnville, the Tennessee Court of Appeals upheld a jury’s verdict in favor of the surviving family of a patient against the nursing home facility that neglected him and eventually allowed him to die, based upon inadequate staffing. The court found that the facility was aware of inadequate staffing at its nursing home, the facility knew that understaffing would lead to decreased care for its residents and patients, and that the facility knew that fewer employees meant higher profits. The Court of Appeals remanded the case for a hearing to consider punitive damages, holding that a reasonable jury could return a finding of recklessness if it believed that the nursing home controlled staffing levels with the knowledge that understaffing would adversely affect its residents.

Nahon, Saharovich & Trotz has legal knowledge and experience in handling nursing home abuse claims involving inadequate staffing and neglect of nursing home residents.  Our law firm litigates against the nursing homes and their parent companies to whom profits means more than people. We have the resources to fight for the nursing home residents and their families, and to bring them justice.