ORANGE COUNTY- North American Health Care (NAHC) appears to have overbilled Medicare by $100 million over the last five years, according to research by SEIU-UHW corroborated in today's Washington Post story, "Review heightens concerns over Medicare billing at nursing homes." Additionally, SEIU-UHW research shows the company has a pattern of falsifying patient care records--this fraud, if proven true, would represent the largest Medicare fraud ever in the nursing home industry.

Court documents reveal that NAHC employees have been ordered to change patient charts to make patients appear more sick or frail. In a sworn deposition, a former Director of Nursing at Rosewood Terrace in Carmichael, CA, states the facility administrator ordered her to go back and alter admission records, stating that "'Everybody that comes in here comes with red, softened heels, and you guys should put that upon admission.'" Separately, a Quality Services Nurse Consultant stated that at three of his facilities, staff was ordered to change patient care records in advance of a state survey.

As the Post confirmed, NAHC billing also points to a pattern of "upcoding" in which nursing homes overbill Medicare by assigning patients billing codes that charge the government for more care than was likely necessary. On average, nursing homes nationally bill less than 5 percent of their Medicare patients in the two most expensive codes, yet NAHC homes bill an average of 67 percent of their Medicare patients to these codes, even though residents in NAHC homes are no more sick than state or national averages.

"The picture this paints is of a rogue company that has likely been bilking Medicare of funds that should go to care for nursing home residents who need services 24-hour a day," said Dave Regan, Trustee of SEIU - United Healthcare Workers West.

The office of U.S. Rep. Pete Stark (D-CA) responded to the research by requesting that the Office of the Inspector General of the Department of Health and Human Services investigate the findings.

"The level of higher-code billing is appalling, especially as California and the nation wrestle with bringing healthcare costs under control," said Regan.

SEIU-UHW hails the recent passage of legislation backed by Representative Stark as part of healthcare reform that makes it easier for federal investigators to know which nursing homes are part of a chain and would give regulators more tools to crack down on abuses.

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With 2.2 million members in Canada, the United States and Puerto Rico, SEIU is the fastest-growing union in the Americas. Focused on uniting workers in healthcare, public services and property services, SEIU members are winning better wages, healthcare and more secure jobs for our communities, while uniting their strength with their counterparts around the world to help ensure that workers -- not just corporations and CEOs -- benefit from today's global economy.

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SEIU-United Healthcare Workers-West (SEIU-UHW) is the largest hospital and healthcare union in the western United States with more than 150,000 members. We unite every type of healthcare worker with a mission to achieve high-quality healthcare for all. SEIU-UHW is part of the 2.1 million-member Service Employees International Union (SEIU), the nation's fastest-growing union. Learn more at www.seiu-uhw.org

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