Prime Healthcare hospitals assert that they do not use a diagnosis of malnutrition to increase reimbursement.

Counting the costs for those programs as reimbursable expenses under the Medicare program would increase total reimbursement in two ways.

To Mr. Bordeau, the records demonstrated a scheme to misrepresent expenses to the Government to illegally increase reimbursement.

And she has recruited elderly people as lobbyists, urging Congress to increase reimbursement so health plans will not drop out of Medicare.

Through a complex formula, that could increase reimbursement, experts said.

Federal investigators are examining whether those fees were deliberately inflated to increase reimbursement.

The civil suit charged that the purpose of the boycott was to pressure Blue Shield, a medical-care insurer, to increase reimbursement to doctors.

But he said it was clear that some had been "made with the intent to increase reimbursement."

So expenses shifted to the Medicare unit from another medical division that treated a smaller percentage of Medicare patients could potentially increase reimbursement significantly.

But the government has contended that Columbia fraudulently added improper expenses onto the home care business to increase reimbursement.