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Nursing Home Fraud

Nursing Home Fraud Whistleblower Lawyer

Nursing homes are entrusted with the care of the vulnerable and elderly. As such, they are expected to provide a certain level of care and make ethical decisions about how they are run. Unfortunately, some nursing homes may perpetuate fraud that can harm their residents, those who have trusted them to care for their loved ones, and taxpayers whose money is funneled into these facilities. Nursing home fraud is an example of healthcare fraud, which primarily centers around Medicare/Medicaid.

If you know about nursing home fraud, whether as an employee, a resident, or a relative or caregiver, there is help available. Speak to an experienced nursing home fraud whistleblower lawyer at Tycko & Zavareei LLP for information. We can help bring unethical nursing home owners and staff to justice, protect your rights as a whistleblower, and provide a voice for vulnerable residents. A consultation with our team is confidential and can help you move forward with peace of mind.

Examples of Nursing Home Fraud

Nursing home fraud can come in many forms. As an employee, resident, or relative of a resident, you may be able to spot things that do not seem right, which others might miss.

Nursing homes and long-term care facilities, particularly larger chains that own and operate multiple facilities, may engage in fraud by:

  • Billing Medicare or the VA for services that were never provided
  • Ordering and billing Medicare or the VA for unnecessary treatments (such as physical therapy or ongoing care) or lab testing that a resident did not require
  • Upcoding or billing for more expensive services than were actually provided to residents
  • Unbundling or de-grouping services to increase the overall insurance payout
  • Failing to provide residents with a care plan that outlines their medical treatment, physical therapy, and nursing needs
  • Failing to follow an existing care plan by prescribing unnecessary treatments or tests

Some nursing homes also commit RUG (Resource Utilization Group) fraud. Many vulnerable residents are in the highest RUG group, making the facilities that house them eligible for the highest reimbursement from Medicare. A facility may attempt to take advantage of this designation in order to bill at higher rates or assign unnecessary treatments in an attempt to increase payouts.

These fraudulent activities may take a toll on residents of nursing homes. When a nursing home defrauds public funds, such as from Medicare, the VA, or other government sources, they may be held accountable for their actions through a whistleblower lawsuit.

Blowing the Whistle on Nursing Home Fraud

One way to hold nursing homes accountable is through the False Claims Act. This law encourages whistleblowers to come forward and share previously undisclosed information about fraud, corruption, and the misappropriation of state or federal funds. Individuals and businesses who violate the False Claims Act can be held liable for treble damages and face separate financial penalties for each indiscretion.

Furthermore, whistleblowers who speak up about these violations may be eligible to receive up to 30 percent of the government’s total award in a successful lawsuit. This area of law, known as qui tam law, works to protect government investments and bring unethical nursing homes to justice.

How Prevalent is Nursing Home Fraud?

Unfortunately, nursing home fraud is an enormous problem across the United States. Nursing homes, especially those run as larger chains, may seek to take advantage of older and vulnerable adults by providing substandard levels of care while charging government programs for top dollar services.

These financial scams compromise the level of care available for elderly individuals and rob families of connection and lasting memories with their loved ones. Preying on the most vulnerable is clearly more than just a financial crime, but nursing homes can be held accountable via financial penalties imposed by successful whistleblower lawsuits.

Recent Examples of Nursing Home Fraud

There have been a number of multi-million dollar judgements against senior centers and nursing homes in recent years. In one case settled against SavaSeniorCare LLC, the nursing home chain agreed to pay $11.2 million in order to resolve False Claims Act allegations. SavaSeniorCare LLC, which runs care centers across the country, was accused of providing “grossly substandard skilled nursing services” and prescribing and billing for medically unnecessary rehabilitation therapy services for residents.

This systematic attempt to increase Medicare payouts allegedly came at the expense of nursing home residents, who received poor care and whose releases from rehabilitation centers were often delayed. According to Acting U.S. Attorney Mary Jane Stewart for the Middle District of Tennessee, “When corporate greed rises to the level of defrauding federal health care programs, while subjecting one of our most vulnerable populations to grossly substandard care and unnecessary medical services, we must hold the companies accountable.”

In another recent case, nursing home chain Consulate Health Care attempted to evade financial penalties tied to the False Claims Act by declaring bankruptcy. The case against Consulate Health Care is expected to settle for $4.5 million, with $3.375 million going to the United States and $1.125 million allocated for the whistleblower in the case, a nurse who came forward after working at two of the facilities run by the chain. However, this judgement is the tip of the iceberg of the larger $256 million civil fraud judgement for which Consulate Health Care was deemed liable under the False Claims Act.

There is much more work to be done in correcting nursing home fraud and rooting out unethical care providers. The law firm of Tycko & Zavareei LLP is ready to put our years of experience and many successful judgements against corrupt healthcare providers to work in cases of nursing home fraud. Speaking up is the first step toward making nursing homes safer places for elderly individuals and keeping the Medicare system a useful network for all who need it.

How to Come Forward as a Whistleblower in Cases of Nursing Home Fraud

If you have information on this subject, contact a nursing home fraud whistleblower lawyer today. The experienced team at Tycko & Zavareei LLP is available to guide you through the process for filing a lawsuit as a whistleblower. We can be by your side every step of the way to bring accountability and ensure that justice is served. Our team are experts at protecting the rights and privileges of whistleblowers and following up on the truth. Contact us today for a confidential, complimentary consultation to see if you have a case.

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