Myocare and Westpark: Mute in the Chart, Speaking With His Family

The Myocare and Westpark false claims case alleged that a nursing home recorded a speaking resident as mute and billed Medicare for unnecessary or nonexistent speech therapy. Four family members brought the case, comparing what they saw during visits with medical and billing records. Their account puts a concrete question in front of anyone who knows a resident’s daily care: does the person described in the chart resemble the person you know?

The complaint named Myocare Nursing Home, Westpark Healthcare, Crestmont North and BHP Management. Filed in federal court in the Northern District of Ohio, it alleged worthless care and neglect involving an elderly family member, false clinical records, and claims for Medicare and Medicaid reimbursement. The sharpest details concerned Westpark’s descriptions of his ability to speak, swallow and walk.

What the Myocare and Westpark Complaint Alleged

The daughters alleged that Westpark recorded their father as mute even though he regularly spoke with them in English and Italian. The complaint’s account placed an ordinary family conversation beside a clinical description that said the conversation could not happen:

The family said the defendants falsely described him as unable to speak for the purpose of repeatedly billing Medicare for speech therapy. In that account, taxpayers were being asked to pay for treatment of an inability the nursing home had invented.

The complaint also identified billing records for allegedly nonexistent and unnecessary speech therapy on multiple dates in October 2017. Those entries gave the family specific claimed services to challenge alongside the description of the resident’s condition.

That is the therapy billing fraud allegation at the center of this account: a claimed inability, treatment supposedly addressing it, and a bill. The family alleged a falsehood at the beginning of that sequence and unnecessary or nonexistent services further along it.

Swallowing Tests and What the Family Saw

A family member said he watched the resident eat cookies, cake, sandwiches and hot dogs. The complaint alleged that Westpark’s records nevertheless asserted that the resident could not swallow, and that records making that assertion were false.

The family also alleged that partial billing records showed claims for nonexistent and unnecessary swallow testing on multiple dates in May 2018.

We bring that account together with the clinical records and people who can explain the treatment.

Basic Care and the Records Describing It

The family’s allegations extended to routine care and mobility. Daughters said they saw dirty feet and unusually long toenails while medical records described regular toenail trimming. The alleged discrepancy was visible during a visit: the care recorded as completed did not match what the family said it saw.

The complaint also alleged that a daughter found pills around the resident’s room, in food and in coffee pots, including pills inside pudding. She believed staff might have been putting medication in food and beverages without the resident or family realizing it.

When one of his daughters asked about taking her father home, the complaint alleged, administrators said he had to remain because he was immobile. She responded that he used a walker and could walk with assistance.

A 1997 California Research Bureau report, Fraud and Abuse in the Health Care Market of California treats billing for services never performed and a repeated pattern of substandard treatment as distinct forms of fraud and abuse. Both questions run through the family’s allegations: what care the resident actually received, and what services the records said he received. The speech and swallowing bills make the claimed-service question especially specific.

How the Care Record Connects to Medicare and Medicaid

The complaint alleged Medicare and Medicaid reimbursement for the resident’s care, and specifically tied the speech-therapy allegation to Medicare.

For speech and swallowing entries, a therapist’s assessment and treatment notes can be compared with the nursing observations and practitioner orders behind the care.

For this case, the comparison starts with the alleged inability to speak or swallow and follows it to the claimed service. We examine who recorded the condition, the clinical support for that description, the treatment documented for the date, and the provider and program on the claim. A family member may know the conversation or the meal. A clinician may know the assessment. A billing employee may know the claim. Each can help explain a different part of the same transaction.

A Resident’s Care Can Be the Center of the Case

Genesis HealthCare’s Potomac Center reached a $600,000 settlement over alleged deficiencies in one resident’s care. In its December 23, 2015 announcement, the Justice Department alleged failures to follow care plans and physician orders, along with inadequate documentation, at the Arlington, Virginia nursing home.

The connection to the Myocare and Westpark allegations is the resident-level detail. A care plan, an order, a description of the resident’s abilities and a treatment entry give an investigator specific representations to examine.

What Evidence Is Needed to Prove Fraud?

For the Myocare and Westpark allegations, the useful nursing home fraud evidence connects family observations, clinical descriptions and particular billed services. The complaint illustrates those connections through conversations, meals, physical care, mobility and the partial billing records the family obtained.

Access to the records was itself part of the family’s account. The complaint alleged that an administrator tried to discourage a daughter from obtaining medical and billing records by saying she would become financially responsible for future medical bills if the records were provided. The family’s eventual allegations nevertheless identified specific speech-therapy and swallow-testing dates.

Our review brings the witness’s account together with the diagnoses, nursing and therapy notes, orders, assessments and claims. We look at who made the entries and how they reached the bill. For a health care employee, that may be the part of the process you worked on every day. For a family member, it may begin with knowing that the resident spoke, ate or walked in ways the records denied.

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

You Know the Resident Behind the Record

If a nursing home’s chart describes care you never saw or abilities you know the resident had, talk with our whistleblower experts about what you witnessed. We build the case with you, connect the care and billing evidence, and bring in nursing home fraud whistleblower lawyers who understand clinical documentation and Medicare and Medicaid claims. We stay beside you as your firsthand knowledge becomes the foundation of the case.