You can support the Department of Justice’s National Nursing Home Initiative by filing a qui tam action under the federal False Claims Act for substandard nursing home care and fraudulent billing practices.
Since March 2020, DOJ has been focusing on long-term care providers, such as nursing homes, sub-acute rehabilitation centers and skilled nursing facilities (SNFs), who provide grossly substandard care to Medicare beneficiaries and/or bill for services that have not been rendered or were “upcoded,” including, rehabilitation treatment, like physical, occupational and speech therapy.
The government is looking for whistleblower cases involving gross abuse and neglect of Medicare patients and blatantly fraudulent billing practices. This includes inadequate care stemming from severely low staffing levels and the use of unlicensed and uncredentialed healthcare providers and aides. It also includes withholding necessary services and activities, including, psychiatric care. Failing to establish or follow plans of care and treatment. And not properly creating and maintaining medical records.
The government is also very focused on significant patient safety issues, like failing to follow
hygiene and infection control protocols. Dispensing unnecessary medications or failing to
provide necessary ones. Housing residents in unsafe or unacceptable living quarters. Failing to
provide adequate food and nourishment. Not attending to bed-ridden patients resulting in
pressure sores. Infrequently bathing and washing residents. Subjecting patients to verbal or
physical abuse. Physically restraining or sedating patients when not warranted. And
inadequately protecting patients’ safety and their personal belongings.
Overbilling and gaming the system for rehabilitation services is also a potential targeted area of
concern. The government is particularly interested in cases where the provider fails to establish
compliance programs and protocols. Turns a blind eye to patient and staff complaints and
warnings. And implements polices and practices that put profits far above quality of care.
Pervasive, long-standing and widespread misconduct involving substandard nursing home care
can result in a provider’s liability under the False Claims Act and a substantial reward to
whoever alerts the government to such conditions.
In the eyes of the law it is improper to file a claim for Medicare reimbursement for services to
nursing home residents knowing the quality of the care was grossly substandard. This is
because every provider’s Medicare claim for reimbursement carries with it an implication that all
material rules and regulations concerning patients’ wellbeing, safety and care have been
complied with. When they have not, then the claim for reimbursement might constitute a false
representation.
If that is what a court or jury finds, then the provider is potentially liable for three times the
amount of the improper payments it received, plus per claim fines of over $25,000, or even
criminal penalties. And, whoever blows the whistle on nursing home or elder care fraud is
potentially eligible for as much as 30% of any funds the government recovers.
The people in the best position to bring successful False Claims Act cases for nursing home
and elder care fraud are current employees. This is because it is important to have or be able to
amass patient-specific and detailed information and evidence corroborating allegations of
substandard nursing home care or Medicare billing fraud.
If you are aware of misconduct in a nursing home or other facility treating seniors and are
confident you have or can obtain strong proof of it, then you should immediately contact an
experienced qui tam whistleblower lawyer to learn about your rights and options.
