How to report nursing home fraud

Nursing Home Fraud

Reporting Nursing Home Fraud can result in successful False Claims Act cases. Billing misconduct and the
provision of substandard care are two key areas to consider in skilled nursing facility (SNF) cases.

1. How do I report Nursing Home Fraud?

One way to alert federal, state and local authorities about Nursing Home Fraud for Medicare and Medicaid
patients is to bring it to the governments’ attention by filing a law suit under the qui tam law provisions of
any applicable false claims act. There are alternative ways, but by bringing a qui tam action you may be able
to get the government to join in your action and you may stand to share in a possible recovery of any money paid back to the government.

2. What kinds of billing misconduct do you find at nursing homes?

Things to look for include: Billing Medicare and Medicaid for medically unnecessary and unreasonable services, such as rehabilitative, physical,
occupational and speech therapies, as well as respiratory, optometry, pharmaceutical and podiatric care. Billing for goods and services that were
never provided. Billing multiple times for the same goods and service. And, billing for goods and services to ineligible patients.

3. What types of substandard of care are of concern in Nursing Home Fraud cases?

The pervasive and systemic failure to provide: daily grooming, hygiene and care services; nursing care, specialized
rehabilitative sessions; pharmaceutical services; and food and dietary services.

4. How can the provision of substandard care support a False Claims Act case?

Skilled nursing facilities have to meet certain “quality-of-care” requirements in order to receive Medicare and
Medicaid reimbursements. When a nursing home falls short of meeting these requirements, but still certifies the
requirements are being met, then the nursing home is a creating false claims and/or making a false statement.

5. What are some other telltale signs of Nursing Home Fraud?

Inadequate staffing levels, widespread bedsore issues, lack of individually tailored care plans and unsanitary conditions.

Nursing-home-fraud

"Tim McInnis is an amazing attorney. He is intelligent, thorough, ethical, kind and he works very strategically in order to insure the best outcome for his clients. I would trust him with my life. He is not only an excellent attorney, but he is a compassionate person."
Denise A. Romano, January 2004

"Tim McInnis is a superb lawyer for whistleblowers. As both a relator and a lawyer I worked with for more than three and a

On October 14, 2020, medical device maker Merit Medical Systems Inc. (MMSI), of South Jordan, Utah, agreed to pay $18 million to settle allegations the company helped submit false claims to the federal Medicare and TRICARE programs and numerous state Medicaid programs by giving kickbacks to physicians and hospitals to induce the purchase and use of MMSI’s durable medical equipment devices and products. NYC attorney Timothy J. McInnis was a member of the legal team that successfully represented the whistleblower in the case, Charles J. (“CJ”) Wolf, M.D., who was the former Chief Compliance Officer of MMSI.

According to Dr. Wolf’s complaint and the government’s settlement agreement, for over six years MMSI paid kickbacks to physicians, medical practices, and hospitals. The payments were made indirectly under the guise of free advertising assistance, practice development, practice support, and so-called “educational” grants. All of this was intended to induce the healthcare providers to purchase and use MMSI’s products, including EmboSphere devices, which are used for uterine fibroid embolization procedures, and QuadraSphere devices, which are used for other types of embolization procedures. Among other things, MMSI used local advertising campaigns to steer patients to healthcare providers as a reward for past sales and to increase future purchases of MMSI products. Dr. Wolf and the government further alleged that MMSI disregarded numerous internal warnings, including from Dr. Wolf, that MMSI’s sales practices potentially violated the healthcare Anti-Kickback Statute (AKS).

The lawsuit was filed in the federal court in District of New Jersey, where attorney McInnis formerly served as an Assistant U.S. Attorney. The case is captioned United States ex rel. Wolf v. Merit Medical Systems, Inc., No. 2:16-cv-01855-CCC-MF (D.N.J.). Of the $18 million MMSI is paying to settle the case, $15.21 million will be go to the U.S. Treasury, and the remaining $2.79 million will go to the approximately 30 individual states that also joined the lawsuit.

half years and his counsel and perseverance were always spot on. His work was critical to a successful settlement of the case."
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"Tim McInnis Law represented my case with the up most professionalism. He communicated with me at every turn of the case ensuring I understood the process as well what was to come next. His patience, comprehension of Qui Tam Law and persistence in getting me the highest amount possible out of the case is unmatched. I wouldn't hesitate to recommend his law firm for a minute."
Don A. Briscoe, September 2016