Nursing home facilities collect billions of dollars in payments each year for the Medicare and Medicaid recipients under their care. Unfortunately, like in all medical sectors, nursing home facilities are susceptible to healthcare fraud. Phoenix healthcare workers who report a nursing home, assisted care facility, or hospice center for fraud against Medicaid or Medicare or other violations of the False Claims Act could be entitled to a significant financial reward.
The whistleblower attorneys at Tycko & Zavareei LLP are nationally recognized for their success in representing whistleblowers who report nursing home fraud. If you have evidence of an assisted living facility in Phoenix committing fraud, contact our Phoenix nursing home fraud lawyers today for a free and confidential case review.
What is the False Claims Act?
Since it was enacted during the civil war, the False Claims Act (FCA) has been one of the government’s most integral defense mechanisms against fraud. The qui tam provision of the FCA allows anyone to become a whistleblower and report fraud by filing a claim on behalf of the government against the company or individual committing fraud. As a way to reward whistleblowers who come forward, the FCA allows the whistleblower to keep a monetary reward between 15 and 30 percent of the total amount recovered.
What is Nursing Home Fraud?
Nursing home fraud usually refers to violations of the False Claims Act. Under the False Claims Act, it is illegal to submit a false or fraudulent claim for payment to a federally-funded program. Because many nursing home residences are Medicare recipients, some healthcare providers may try to obtain unwarranted funds. Common types of healthcare fraud seen in Phoenix nursing homes include:
- Billing for a level of care that a resident does not qualify for
- Billing for items or services that are not medically necessary
- Billing for items or services that were never provided to a resident
- Unbundling or billing for each stage of a service or procedure as if they were separate services or procedures
- Upcoding or billing for a more complex service or procedure than what was actually given to the patient
- Filing more than one claim for one service
- Writing unnecessary prescriptions or altering prescriptions
- Violations of the Stark law and Anti Kickback Statute, or the practice of making or accepting payments for referrals
- Billing for abusive or negligent care
- Misrepresenting who administered a service or procedure or where the service or procedure was administered
If you have evidence of nursing home fraud, including any of the above-mentioned FCA violations, you may have grounds for a nursing home fraud lawsuit. Contact the Phoenix lawyers of Tycko & Zavareei LLP today for a free nursing home fraud case review.
Who Can Become a Whistleblower?
Anyone with evidence of fraud can become a whistleblower. In most Phoenix nursing home fraud cases, the whistleblower is usually an employee or former employee who has evidence of fraudulent activity. Other non-employees who become Phoenix nursing home fraud whistleblowers include residents, consultants, and contract workers.
Why Does Nursing Home Healthcare Fraud Occur?
Nursing homes and other healthcare providers use complicated medical codes when billing healthcare programs like Medicare and Medicaid. Without experience in medical coding, most would not be able to find the falsified information that is being hidden within the medical jargon. This is why nursing home fraud whistleblowers are usually employees of the companies that violate the FCA.
How Are Phoenix Nursing Home Fraud Whistleblowers Protected?
Because nursing home fraud whistleblowers are usually employees, many potential whistleblowers are apprehensive about reporting fraud out of fear that their employer will retaliate against them. Under the FCA, whistleblowers and qui tam relators who report FCA violations are protected from employer retaliation such as being fired, demoted, suspended, threatened, harassed, or otherwise discriminated against for becoming a whistleblower. The FCA allows whistleblowers who do experience retaliation to file a separate claim against their employer for reinstatement and additional damages.
Past Arizona Nursing Home Fraud Cases
In 2021 alone, whistleblower lawsuits brought under the FCA resulted in the recovery of over $5.6 billion. Notable nursing home fraud lawsuits in the Phoenix area include:
- 2017: Multiple hospice companies across the country, including Phoenix Hospice, LP, agreed to pay $12.2 million to settle claims regarding a kickback scheme.
- 2021: Bayada, a home healthcare service with six locations in Tuscon agreed to pay $17 million to resolve allegations regarding kickbacks for Medicare referrals.
- 2022: Hacienda Healthcare, a Phoenix nursing home facility, was ordered to pay $11 million to settle claims regarding overbilling Medicaid.
Contact a Phoenix Nursing Home Fraud Attorney
Phoenix whistleblowers with valuable information regarding nursing home fraud and other types of healthcare fraud could qualify for a significant whistleblower reward. If you are considering filing a nursing home fraud qui tam claim, a qualified attorney can help you file a qui tam lawsuit, urge the government to take on your case, and fight for the maximum whistleblower reward for your contributions and bravery.
A Phoenix nursing home fraud lawyer can handle your qui tam claim from start to finish. Our firm has worked with whistleblowers across the country to protect taxpayer dollars and have successfully recovered over $8 billion in defrauded funds. If you have evidence of nursing home fraud in Phoenix, contact the lawyers of Tycko & Zavareei LLP today for a free legal consultation.
