Life Care Lawrenceville: The Gap Between the Bill and the Bedside

Life Care agreed to a $2.5 million settlement in 2005 to settle the Life Care Lawrenceville fraud case over allegations that the nursing home billed Medicare and Medicaid for care that failed to meet residents’ needs. The government’s account included residents allegedly dying after failures in medication monitoring and basic hygiene. For nursing home staff who know what happened between the care plan and the bedside, this case connects alleged care failures to government billing and the people responsible for running the facility.

Life Care Center of Lawrenceville was a 125-bed skilled nursing facility in Lawrenceville, Georgia, operated by Life Care Centers of America. Its consent order combined a settlement payment with obligations aimed at the care residents received afterward. The later national Life Care therapy settlement concerned a different period and different conduct.

The Care Behind the Medicare and Medicaid Claims

The federal government and Georgia alleged that Lawrenceville submitted claims for nursing and other health care services that failed to meet residents’ needs from January 1, 1998 through November 30, 2005. The allegations covered diabetes treatment, nutrition and hydration, resident assessments, care planning and nursing interventions, medication management, fall prevention and management, and pressure-ulcer prevention and treatment.

In testimony to Congress on May 15, 2008, the Department of Health and Human Services Office of Inspector General linked the alleged care failures at Lawrenceville to chronic understaffing. It described the government’s allegation that a resident taking the blood thinner Coumadin died of toxic poisoning after staff failed to check his blood-clotting times. Another resident allegedly fell four times during a four-month stay, fracturing and refracturing her hip.

The testimony also described an allegation that a resident developed maggots in her mouth and died of larvae infestation after staff failed to provide basic oral hygiene.

The same testimony explained why the government pursued care failures under the False Claims Act. The issue was billing the government for care so poor it amounted to no care at all. Residents suffered the alleged failures, and taxpayers faced the bill for the care.

Who Operated Life Care Center of Lawrenceville?

Life Care Centers of America operated the facility, while Gwinnett Operations owned it.

In its wider account of nursing home ownership, the Inspector General described chains separating real estate, facility operations and daily management into different businesses. An operating company could hold no assets, sublease the building and contract out management. Following those relationships helps connect decisions about care to the people controlling the money.

At Lawrenceville, the order specifically assigned the settlement payment to Life Care.

Whistleblowers brought the qui tam case, and the United States joined it.

What Did the Lawrenceville Consent Order Require?

The Lawrenceville consent order required Life Care to pay and required the owner and operator to implement a Corporate Integrity Agreement with the Office of Inspector General immediately when the order took effect. The agreement addressed the quality of care inside the facility.

The Inspector General’s testimony described how these agreements strengthen quality assurance and communication within a healthcare organization. Independent quality monitors used state survey results and Quality Indicators/Quality Measures derived from the Minimum Data Set to identify problems with care. That gave resident assessments a role beyond the individual chart: monitors could compare care across facilities and track improvement or deterioration over time.

The order also barred Life Care from passing the settlement, defense and specified monitoring costs back to government programs through its bills or cost reports.

A Possible Change in Who Ran the Home

If Life Care or the owner failed to comply, the court order allowed the government to seek a temporary manager for Lawrenceville or ask the court to compel compliance. If the court found that they had disobeyed its order, a $10,000 daily penalty could apply until they corrected the failures. The settlement’s reach extended from a payment obligation to the possibility of changing who managed the nursing home.

What Evidence Is Needed to Prove Fraud?

We build care-based nursing home fraud cases by connecting residents’ needs, the care actually delivered and the claims submitted for payment. Staffing and management records help explain who made the decisions behind that care.

The California Research Bureau’s 1997 report on fraud and abuse in California’s health care market described the pattern behind repeated poor care:

The alleged repeated falls and missed medication checks at Lawrenceville make that pattern concrete. We connect nursing notes and hospital records to what the facility claimed it provided. A nurse or aide may know the daily care history, while someone handling claims may see what the facility told the payer.

We compare staffing schedules with payroll and agency invoices to understand who was actually working when residents needed care. Management agreements and ownership disclosures help us trace who controlled staffing and spending. An insider’s account ties those business records to what happened on the floor.

A Similar Care Pattern at Ciena

The same Inspector General testimony described a separate settlement with Ciena Healthcare Management in 2007 over alleged Medicare and Medicaid claims for deficient care at four Michigan facilities. The alleged failures included nutrition, hydration, assessments, care planning, medications, falls and pressure-ulcer care.

The resulting quality-of-care agreement covered all 32 Ciena facilities. That is a useful comparison with Lawrenceville: the facilities whose care generated the allegations and the facilities covered by the remedy can be different. The scope of the oversight tells an employee which operations the settlement was meant to reach.

Life Care’s Later National Therapy Settlement

The national Life Care settlement announced on October 24, 2016 required $145 million over allegations involving medically unnecessary rehabilitation therapy. Its covered period ran from January 1, 2006 through February 28, 2013. The government alleged that corporate efforts to maximize the highest-paying therapy classifications and prolong stays overrode treating therapists’ judgments about when treatment should end.

That case concerned Medicare and TRICARE therapy claims and brought a five-year, chain-wide integrity agreement with independent review of therapy necessity and appropriateness. Lawrenceville’s earlier order addressed the alleged local care failures described above.

The Justice Department announced a $29 million whistleblower award in the national case. More generally, a whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know What Happened on the Floor

If you saw residents go without the care the nursing home billed for, speak with our whistleblower experts about the care and claims you know. We bring in nursing home fraud whistleblower lawyers who understand clinical records and government billing, and stay beside you to build your strongest nursing home whistleblower case.