Department of Justice Files False Claims Act Complaint Against California Nursing Homes

On August 29th, the U.S. Department of Justice filed a complaint against two California-based nursing home facilities known as Country Villa Watsonville East and Country Villa Watsonville West – both of which participate in both Medicare and Medicaid (Medi-Cal). The complaint alleges horrific patterns of patient neglect, including the administration of government-reimbursed medications in order to render patients “more manageable” for Country Villa staff.

The complaint, which was filed in United States District Court for the Northern District of California, advances the claim that Country Villa not only owes compensatory damages to the government for wrongful conduct toward Medicare and Medi-Cal patients, but seeks damages under the common law theories of unjust enrichment and payment by mistake. In addition, the False Claims Act allows for treble statutory damages ranging from $5,000 to $11,000 per violation.

Details of Claims Against Country Villa

Federal and state laws impose strict regulatory and compliance standards that apply to any facility that services beneficiaries enrolled in the Medicare or Medi-Cal programs, including mandatory quality of care standards. Failure to meet the standards as set forth by CMS and California law, and the subsequent billing for such services to the federal and state governments, can trigger exposure to liability under the False Claims Act.

One pivotal regulation in the case against Country Villa pertains to quality care standards for 24-hour nursing services. All nursing staff must be trained in proper protocol to sufficiently meet the needs of residents, which includes “maintenance of complete and accurate clinical records, avoidance of medication errors, acceptable nutrition, proper treatment of pressure sores and urinary incontinence, and provision of adequate supervision and assistance devices to prevent accidents.”

This regulation also requires that residents covered by Medicare/Medi-Cal be “free of unnecessary drugs,” defined as “any drug when used in excessive dose, for excessive duration, without adequate monitoring, or adequate indications for its use, and/or in the presence of adverse consequences.” This includes the administration of drugs for convenience or discipline, and prohibits the use of “chemical restraints.”

According to the complaint, for a period spanning from 2007 through 2012, the defendants consistently submitted invoices for patient care that was “non-existent, grossly inadequate, materially substandard, and/or worthless” – amounting to total government payments topping $20 million.

The specific allegations of misconduct by nursing staff are particularly horrific, including:

• Use of narcotics, psychotropics, antipsychotics, hypnotics, and anti-anxiety drugs to treat dementia, depression and pain;
• Failure to document the administration of drugs to patients
• Administration of the powerful drugs Ativan and Seroquel to a patient, following a fall, without doctor’s orders
• Administration of the painkillers Vicodin and a Duragesic Patch without a care plan or adequate monitoring
• Administration of the sulfa-containing drug Celebrex to a patient with a known sulfa allergy
• Provision of expired medications
• Failure to monitor patients after administering sedatives
• Provision of medications without food or water
• Failure to adequately refrigerate medications and vaccines
• Neglect of patients leading to acute pressure sores and dehydration

The government’s complaint offers several anonymous, real-life examples of the patient care, or lack thereof, offered to residents of Country Villas.

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