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.