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$60 Million Dollar Medicaid Fraud Lawsuit Against Major Nursing Home Chain

Senior on wheelchair

A major nursing home chain with locations in Aurora, Rockford, and Dixon, Illinois is in the middle of a $60 million lawsuit brought by the U.S. government. The lawsuit alleges that Meridian Senior Living Group (some former Meridian facilities are now owned by Affinity Living Group) submitted at least that amount in false billings to North Carolina’s Medicaid program for services provided in their facilities’ Special Care Units. These units are intended to treat specialized conditions within long term care facilities and nursing homes. The lawsuit names 45 separate Meridian facilities in North Carolina, Meridian’s owner, and their management and billing departments. As a combined entity, Meridian and Affinity operate the most adult care facilities in the state of North Carolina and are one of the top 10 largest adult living networks in the country.

Scam: Too Few Staff for High Billable Care Hours
Information about the scheme was brought forward by a whistleblower who was aware that the submitted claims to Medicaid were purposely overstated to reflect more frequent and extended periods of care than were actually provided. Among other allegations, the whistleblower alleges that the number of staff to the number of residents could never provide for the amount of 1:1 care for which Meridian Senior Living facilities billed. The facilities are accused of charging Medicaid for 1.5 – 1.75 more hours on average than a staff member actually spent with a resident. The lawsuit also alleges that Meridian would bill the maximum allowed per month, regardless of the release date or the date on which a resident was given a diagnosis, a requirement for allowing certain charges to be submitted and reimbursed by Medicaid.

Nursing Home Chain Padding Its Pockets at Everyone Else’s Expense
Nursing homes that take advantage of federally and state funded programs like Medicaid are filling their pockets by taking from others who rely on the programs to survive. Currently, federal funds earmarked for Medicaid are determined using criteria such as per capita income, with states themselves kicking in the rest. State budgets are preset, allowing a finite dollar amount each year to be contributed to the program. Nursing homes that overstate the care provided and submit these charges are robbing those who actually require services by lessening the amount available. This harm hurts children, the elderly, and those with acute or chronic needs that rely on Medicaid for healthcare and other services.

Those residents and patients that are the subject of false claims are being used to make greedy nursing homes richer, while also misleading taxpayers into thinking Medicaid costs are spiraling out of control for those receiving nursing home care. It’s impossible to paint an accurate picture of the Medicaid landscape of a state when $60 million in charges are said to be fraudulent.

3 Meridian Senior Living Facilities in Illinois
While the pending lawsuit only relates to Meridian Senior Living Centers in North Carolina, it is a reminder that the integrity of a nursing home chain or individual facility is an important consideration when choosing the right nursing home to care for a loved one. The whistleblower who exposed the fraud in Meridian’s North Carolina facilities handed over evidence that proved current staffing levels could not have merited such high billings to Medicaid. Staffing, one of the ways in which many nursing homes cut corners in order to save money, is a major contributor to nursing home abuse and neglect. Stressed, overworked employees with too many residents to care for creates a prime environment for tragedy to occur.

Meridian currently operates 3 facilities in Illinois: Bright Oaks of Aurora in Aurora, The Atrium in Rockford and Liberty Court in Dixon.