Momence Meadows: Why the Nursing Home False Claims Verdict Was Overturned

In the Momence Meadows fraud case, an appeals court threw out a $9,091,227 government damages judgment over allegations that the nursing home hid scabies and pressure sores from records used for payment. Former nurses had described serious care problems and efforts to hide them. What the case lacked was evidence connecting those problems to even a rough count of false payment certifications. For someone who knows what happened on the floor and what disappeared from the chart, that missing connection is the heart of the case.

The Seventh Circuit’s opinion describes Momence Meadows Nursing Center as a 140-bed long-term-care facility in Kankakee County, Illinois. Two former nurses, a licensed practical nurse and a registered nurse, brought the qui tam case against the company and its president and part owner, alleging false claims to Medicare and Medicaid. The United States and Illinois declined to join the case.

How Momence Meadows Was Paid

During the period examined in the opinion, from 1998 to 2006, Medicare and Medicaid paid Momence a daily amount for each covered resident. Almost all of its residents depended on one of those programs. The payment covered the resident’s day of care rather than a separate bill for every service.

The facility’s Minimum Data Set assessments connected the resident’s condition to that payment. The MDS forms recorded diagnoses, health conditions and other assessment information. They tied payment to the accuracy of that information, with a promise made about each resident:

That made a charting decision consequential beyond the nursing station. The whistleblowers alleged that symptoms disappeared from the records used to describe residents to the government. Their false-certification case centered on whether the MDS forms accurately reported the residents’ conditions and treatment.

In a nursing facility, the assessment draws on observations, the resident and direct-care staff across shifts. A registered nurse conducts or coordinates it, and contributors certify their own portions. An MDS coordinator’s completed form depends on the clinical work underneath it. The nurse who observed a condition, the person who entered the assessment and the employee who handled billing may each hold a different part of the same payment story.

Momence’s president and part owner was responsible for policies governing the facility’s management and operation and appointed its administrators. The opinion describes allegations about decisions below that level too: supervisors directing chart entries and an administrator managing the facility’s response to inspectors. Those roles matter because the alleged concealment involved choices about what staff recorded and what the government saw.

What the Nurses Said Was Hidden

The whistleblowers presented evidence of scabies outbreaks, problems managing pressure sores, and shortcomings in medication, cleanliness and equipment. They also presented testimony that supervisors told employees to leave scabies and pressure-ulcer symptoms out of charts, or describe them as something else. According to that testimony, charts containing the symptoms were hidden.

The alleged changes extended to the building itself. Witnesses described ordinary understaffing followed by increased staffing when government surveyors arrived. New linens and nightgowns appeared during inspections. An administrator allegedly used a coded announcement to alert staff to an unscheduled survey.

According to the testimony, residents lived with understaffing while inspectors saw extra staff and new nightgowns. The bedside records mattered for the same reason: if a condition was left off the chart, someone reading the assessment later could see a different resident from the one the nurse had treated.

Why the Worthless-Services Argument Failed

The jury had been told it could treat care worth less than the government paid as worthless care. The appeals court rejected that instruction: the care had to be so deficient that it amounted to effectively no care at all, and the evidence did not show that at Momence.

The MDS Certifications and the Missing Count

The false-certification argument failed because the whistleblowers did not establish even approximately how many MDS forms contained false information. The court accepted that a jury could regard the forms’ accuracy certification as a condition of payment. The gap was in proving the false certifications.

The jury had found 1,729 of them. The appeals court asked what evidence supported that count. Testimony about how many forms the facility created answered how much paperwork existed, but the verdict depended on how much of that paperwork was false.

The clinical evidence pointed to omissions. During a scabies outbreak, the records showed no correlation between residents’ symptoms, diagnoses and treatment. Pressure-ulcer reporting dropped to none in some months between months with numerous ulcers. A government survey found failures to track rashes, and witnesses described directions to avoid recording scabies.

Those were concrete discrepancies. The court nevertheless found that the evidence did not establish how many residents had unrecorded symptoms, how many ulcers went undocumented or how many assessments consequently contained false certifications. The case had described the problem without supporting the count on which the verdict rested.

A detail in the opinion makes that gap tangible: the whistleblowers introduced a blank MDS form but no billing records for individual residents. The blank form showed the promise of accuracy. It could not show what the facility had actually certified about a particular resident.

The court discussed statistical or other evidence that could support an approximate number. Its concern was the absence of evidence supporting even that approximation. The resident’s condition, the assessment and the payment were parts of the same story, but the evidence had not connected them.

The nurses also presented evidence of broken promises to inspectors about documentation and staff training. Those promises were never put to the jury as statements Momence knew were false when it made them.

Other Nursing Home Cases Show the Payment Connection

The Salus Rehabilitation case produced different results for Medicare and Medicaid claims. In its June 25, 2020 decision, the Eleventh Circuit restored the Medicare verdict while leaving judgment for the defendants on the Medicaid claims. The Medicare allegations involved upcoding that affected reimbursement. The Medicaid allegations concerned care plans and whether the care-plan requirements mattered to payment.

That split makes the Momence lesson concrete. The payment program, the representation and the supporting evidence have to be examined together. Even within a single nursing-home case, the answer can differ by claim.

The government’s complaint against Life Care Centers of America described managers choosing assessment dates to reach higher therapy payment categories, known as RUG levels:

That allegation identifies who overrode the assessment coordinator, which decision changed and the payment result sought. The assessment date became a revenue decision.

In the separate whistleblower complaint against Myocare Nursing Home, family members alleged that records described a resident as unable to speak even though he spoke with them regularly. They also identified billing dates for allegedly nonexistent or unnecessary swallowing tests. The allegations put observations about an individual resident alongside medical entries and billing records. That is the kind of connection a broad account of poor care leaves unfinished.

What Happened to the Momence Meadows Award?

The appeals court threw out the government damages judgment and directed a ruling for Momence and its president and part owner. The judgment had tripled the jury’s damages award.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

What Evidence Is Needed to Prove Fraud?

For nursing home fraud involving care and assessment records, the evidence needs to connect the resident’s condition to what the facility reported and billed. Working out which records make that connection is part of the case assessment we undertake with you.

You Know What the Chart Left Out

If you saw a resident’s condition disappear from an assessment or know how management controlled what reached billing, speak to one of our whistleblower experts about what the chart left out. We work beside you to connect the clinical decisions to the government’s payments and bring in nursing-home fraud whistleblower lawyers who understand assessment and billing evidence. We stay with you through the case, building your strongest nursing home whistleblower case.