Many families make the difficult decision to move a loved one into a nursing home or a long-term care facility when they are no longer able to care for themselves either due to age, disease, or disability. Families of nursing home residents trust that the facility they place their loved one in will provide an expected level of care and adhere to the appropriate standards and guidelines. Because many residents of skilled care facilities are Medicaid or Medicare recipients, some of these care facilities choose to place profits over their patients in order to maximize the payouts they receive.
Employees or other individuals with evidence of fraud taking place in nursing homes or skilled care facilities may receive significant financial compensation if their whistleblower lawsuit is successful. If you have proof of healthcare fraud taking place in an assisted living facility, contact the Florida nursing home fraud whistleblower lawyers of Tycko & Zavareei LLP today for a free, confidential qui tam case evaluation.
What is Nursing Home Fraud?
Nursing home fraud refers to questionable billing practices and other illegal or unethical business tactics that violate the False Claims Act (FCA). Common examples of fraud in nursing homes include:
- Overbilling or inflating the price of goods or services that were provided
- Billing for goods or services that were not provided
- Billing for a patient who is unqualified for the level of care received or billed for
- Substandard or inadequate equipment or staffing
- Misrepresentation or falsification of a patient’s records
- Offering illegal kickbacks or incentives for the referral of Medicaid or Medicare patients
What is the False Claims Act?
Sometimes referred to as Lincoln’s Law, the False Claims Act (FCA) is a federal law that makes it a crime for any individual or business to knowingly and intentionally submit a false or misleading claim to the government or any of its programs. The FCA contains a qui tam provision that allows private individuals who have evidence of fraud to bring a lawsuit against the perpetrator on behalf of the US government.
How are Nursing Home Fraud Whistleblowers Protected and Rewarded?
The FCA and other whistleblower protection laws forbid employers from retaliating against whistleblowers for coming forward with a qui tam claim. Under the FCA, no whistleblower should be fired, demoted, suspended, harassed, or otherwise discriminated against because they filed a whistleblower claim. Whistleblowers who do experience retaliation may qualify to file a separate lawsuit against their employer for the damages they incurred as a result of the retaliation.
Besides offering protection to whistleblowers, the government also incentivizes qui tam relators to come forward with proof of fraud by rewarding the whistleblower a portion of any financial recovery that is made. A whistleblower may be entitled to between 15 and 30 percent of the total funds that are recovered, depending on whether the government intervenes in the case.
Why Should I Report Nursing Home Fraud?
In 2019, the US government spent close to $3 billion on long-term care, including nursing homes and assisted living facilities, through its public healthcare programs like Medicaid and Medicare. According to the Centers for Medicaid and Medicare Services, the improper payment rate for Medicaid and Medicare is as high as 21 percent, equating to the loss of millions of dollars to fraudulent claims each year. With these programs funded by tax dollars, it is American taxpayers who ultimately pay the price when Florida nursing homes or other medical providers defraud public healthcare programs.
Prioritizing profits over patients also inherently puts the residents of long-term care facilities at risk. Care facilities may choose to evade regulations and take shortcuts in their staffing, the services they provide, and the care they give to the residents in order to profit off of programs like Medicaid and Medicare. Besides potentially receiving a financial reward, whistleblowers who report fraud also help to keep residents safe.
Nursing Home Fraud Whistleblower Lawsuits
Consulate Health Care, a nursing home chain based in Florida, was hit with a $256 million civil fraud judgment for committing fraud against Medicare and Medicaid. Unable to pay the sum, the company agreed to file for bankruptcy and sell some of its facilities in addition to paying $4.5 million to the Department of Justice and the whistleblower.
In Florida, Hebrew Homes Health Network Inc. settled allegations regarding FCA and Anti-Kickback Statute violations for $17 million. The qui tam lawsuit was brought by the company’s former CFO, who received a financial reward for his efforts as a whistleblower of $4.25 million.
What is the Florida False Claims Act?
The Florida FCA mirrors the federal FCA and makes it illegal to submit fraudulent or falsified claims to the state. Like the federal FCA, Florida’s version of the law also rewards whistleblowers if their contributions as a whistleblower lead to financial recovery. The Florida FCA also grants whistleblowers protection from retaliation for claims filed under its whistleblower program.
Contact a Florida Nursing Home Fraud Whistleblower Attorney Today
The nursing home fraud attorneys of Tycko & Zavareei LLP are nationally recognized for their efforts to uncover deceitful and unethical business practices and have worked with whistleblowers across the United States to uncover all types of fraud, including healthcare fraud, government contracts fraud, and securities fraud. If you have evidence or inside knowledge of fraud or other violations of the FCA taking place in a nursing home or in another medical setting, call the Florida nursing home fraud whistleblower lawyers of Tycko & Zavareei LLP today to speak with a qualified attorney.
