Fraud occurs with surprising frequency in facilities with especially vulnerable patients. For this reason, nursing homes can be easy targets for Medicare and Medicaid fraud. These facilities are not under as much official scrutiny as hospitals. Nursing home residents are often unable to advocate for themselves. It is up to whistleblowers who have insight into this type of wrongdoing to expose it.
Common examples of fraud at nursing homes include:
- billing for unnecessary tests and procedures;
- paying kickbacks to doctors for referring patients to the nursing home; and
- receiving kickbacks, rebates, or other benefits for prescribing drugs or using medical devices.
For-profit nursing home providers have frequently been defendants in whistleblower claims. Recently, nursing homes have settled cases with accusations of Medicare fraud and illegal kickbacks. The whistleblower statutes provide for a percentage of any recovery to go to the whistleblower, even when the government intervenes on the whistleblower’s behalf.
More than a dozen nursing home operators have settled whistleblower lawsuits with the Justice Department in cases with allegations of improper Medicare billing, forged documents, and other abuses. One nursing home provider in Tennessee is still in litigation with the government over accusations of putting residents into unnecessary therapy services and delaying the release of patients in order to reap higher Medicare benefits.[1] A nursing home in California settled a whistleblower lawsuit for $6.9 million for an illegal kickback scheme of tickets to sporting events and yacht excursions for hospital planners that provided patient referrals.[2] One of the largest nursing homes in country settled a whistleblower lawsuit for $145 million to resolve allegations that it engaged in a systematic scheme to maximize Medicare billing.[3]
It is clear healthcare fraud occurs in nursing homes through the United States. The settlements discussed above are just some of the many lawsuits detailing the extent of the fraud. It leads you to wonder if any nursing homes in Virginia could be guilty of the same fraudulent conduct?
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[1] Moreno, Edward. Nursing Home Providers Accused of Misusing Federal Dollars Received Millions in COVID-19 Funds: Report. The Hill (Aug. 4, 2020). Available at https://thehill.com/policy/healthcare/510529-nursing-home-providers-accused-of-misusing-federal-dollars-received.
[2] Cenpizer, Debbie. Nursing Home Companies Accused of Misusing Federal Money Received Hundreds of Millions of Dollars in Pandemic Relief. Washington Post (Aug. 4 2020). Available at https://www.washingtonpost.com/business/2020/08/04/nursing-home-companies-accused-misusing-federal-money-received-hundreds-millions-dollars-pandemic-relief/.
[3] Life Care Centers of America Inc. Agrees to Pay $145 Million to Resolve False Claims Act Allegations Relating to the Provision of Medically Unnecessary Rehabilitation Therapy Services. Office of Public Affairs, U.S. Dept. of Justice (Updated Apr. 27, 2017). Available at https://www.justice.gov/opa/pr/life-care-centers-america-inc-agrees-pay-145-million-resolve-false-claims-act-allegations.