Benton, Illinois — A Michigan physician group that built its business on caring for nursing home patients must now face a federal jury over allegations it ran a years-long Medicare billing scheme — after a federal judge refused to let the company escape without a trial.
US District Judge Staci M. Yandle of the Southern District of Illinois last week denied a motion for summary judgment filed by General Medicine P.C., 17 related shell companies, and the firm’s founder and owner, Thomas Prose, MD. The government says enough factual disputes exist to warrant a jury’s judgment on whether the company submitted false claims — and whether it did so knowingly.
What the Government Says
General Medicine is a Novi, Michigan-based “post-hospitalist” company specializing in the care of post-acute patients inside skilled nursing and assisted living facilities. Between April 2016 and March 2021, the company collected more than $40 million from Medicare Part B alone. Federal prosecutors allege a substantial portion of that money came from fraudulent billing.
According to the lawsuit, the company set monthly patient-visit quotas for its doctors and nurse practitioners — without any consideration of whether the patients actually needed the services. Claims were submitted for visits that were medically unnecessary, duplicated, or inflated. Nursing homes and assisted living facilities, officials say, often didn’t even know the 17 shell entities existed and believed they were dealing solely with General Medicine P.C.
The Justice Department intervened in the case after a whistleblower originally filed the complaint.
The Defense’s Argument — and Why the Judge Rejected It
General Medicine argued its billing discrepancies didn’t rise to the level of fraud under the False Claims Act’s legal standard. The company said the government failed to show the company acted with the required intent.
Judge Yandle disagreed. In her opinion, she found the government had pointed to genuine factual disputes on both whether the claims were false and whether the defendants acted knowingly — meaning those questions belong in front of a jury, not a judge.
Providers have historically preferred to settle False Claims cases before trial rather than risk the law’s treble-damages exposure. Going to trial, especially on a case with this much alleged volume, raises the stakes considerably for Prose and his network of companies.
Why This Matters for the Industry
The General Medicine case is a reminder that the government views SNFist billing arrangements as a serious enforcement priority. The structure at the heart of this case — physician groups using multiple shell entities to bill for nursing home patient services — mirrors patterns federal investigators have flagged across the country.
It’s not the only billing pressure nursing facilities are navigating. Industry reports have also tracked how aggressive Medicare recoupment actions are landing on operators, with Medicare clawback demands threatening to push some facilities to the edge of closure.
The General Medicine trial is expected to put further scrutiny on how SNFist practices document and bill for patient encounters — a question that carries real weight for every skilled nursing operator with a contracted physician group on site.
No trial date has been publicly set as of press time.
Discover more from Skilled Care Journal
Subscribe to get the latest posts sent to your email.
