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The government prosecuted a case under 18 U.S.C. § 1347, alleging violations of 42 C.F.R. § 483.15 and 42 C.F.R. § 483.25. Defendants Marth Bell and Atrium I Nursing and Rehabilitation Center were found guilty. In a post-trial motion, Defendants argued that the standards of care in 483.15 and 483.25 are vague and ambiguous. The court denied Defendant's motion, finding that the government's case was not merely a failure to meet the required standards of care, but for health care fraud based on a scheme to falsify records in an attempt to conceal from State and federal agencies the substandard care being provided. The court found that Defendants' conduct went well beyond a mere failure to provide care and elevated the wrongdoing to criminal fraud.
See McLain v. Mariner Health Care, Inc., 279 Ga. App. 410 (Ga. Ct. App. 2006) (discussing Medicare and Medicaid regulations as evidence of the standard of care).
Other Department Appeals Board decisions are at: http://www.hhs.gov/dab/decisions/browsedab.html.
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