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.