Nursing Home and Hospice Fraud
Healthcare fraud is a plague to medical institutions across the industry, but it’s especially unsettling when it occurs in facilities that house vulnerable patients. Nursing homes and hospice care facilities work closely with Medicare and Medicaid to provide their patients with the prescriptions, treatment, and care they need in their golden years. Unfortunately, some of these institutions will attempt to capitalize on the weakened state of seniors and employ fraudulent methods in an attempt to benefit their organization financially. This creates a hazardous environment for seniors, as the organization that’s supposed to protect them is actively trying to use them in a scheme for a bigger paycheck.
Nursing home and hospice care centers aren’t under as much supervision compared to hospitals and doctors’ offices, which offers the perfect opportunity for anyone trying to commit fraud. To make matters worse, these fraudulent organizations conceal their wrongdoings behind closed doors and out of the public’s eye, making it difficult for anyone outside the organization to realize there’s a crime occurring. However, there is one key factor that the people have against healthcare fraud in any institution: the courageous whistleblower. These brave individuals are often employees of the unethical organization and can gather the necessary evidence to start a lawsuit.
As a whistleblower, you’re taking a stand against corruption and helping to enforce fairness across all of our federally funded programs. Our Complex Litigation Group serves as an ally to whistleblowers anywhere. We have the unique capability to help you find success in your qui tam or whistleblower lawsuit, all while staying protected and anonymous. We’ve already helped more than 100,000 clients and recovered multi-million dollar settlements in the name of justice and fairness, but the job isn’t done yet. If you have knowledge of fraud occurring at your workplace or another nursing home/hospice facility, contact us today for more information on how to use your evidence for the greater good.
All Forms of Nursing Home Fraud Are Intolerable
Healthcare fraud will look differently depending on the facility it’s occurring within, but here are a few examples of common fraudulent practices:
- Billing for unnecessary treatment and procedures
- Offering kickbacks to medical professionals for referring patients to their facility
- Receiving kickbacks or benefits for prescribing specific medications
- Billing for “phantom” patients
- Double-billing for the same service
While these fraud schemes are common across all healthcare facilities, there are many more methods that people will use to defraud the government. In fact, there have been cases of nursing home staff purposefully keeping their patients sick to qualify for more federal funding, which is especially unacceptable when you consider that many of these patients are too weak to fight back.
Healthcare Facilities Must Abide by Federal and State Guidelines
Nursing homes must provide residents with adequate medical care and sanitary living conditions per federal and state guidelines. If they fail to do so, they could be held liable for any harm that results from their negligence. Some nursing homes will fraudulently bill Medicare and Medicaid despite having unhealthy patients and poor living conditions. These organizations will claim that they’re using the federal funding to provide treatment for their patients, but in reality, they’re putting that funding into their own pocket rather than using it to improve the life of the patients who depend on them.
Nursing homes claim they’re providing for their patients to receive federal funding is in direct violation of the False Claims Act. Any private citizen with knowledge of fraud can file a lawsuit on behalf of the government through the False Claims Act, but they must first have concrete evidence that the crime is occurring. If your workplace commits any of the following health and safety violations and is billing for federal funding in the process, you could be eligible to file a lawsuit:
- Failure to provide a safe and clean environment for patients
- Failure to administer medications or treatments that have been prescribed and paid for by Medicare or Medicaid
- Failure to meet minimum staffing requirements
- Failure to routinely move patients for bedsore prevention
- Administration of dangerous medications or unorthodox treatments without the patients’ knowledge or consent
Hospice Care Fraud Stops With You
Hospice facilities care for patients who don’t have much time left, but that doesn’t mean these individuals deserve to be mistreated. Most hospice patients will require significant treatment and therapies to improve their quality of life in the final years, which some hospice organizations will see as an opportunity to profit. Seemingly minor instances of fraud, such as double-billing, can add up over the years to result in millions of dollars in stolen taxpayer dollars. If they hadn’t committed a crime, that funding could have been used to provide the treatment someone needs to live. Unfortunately, hospice care fraud has become increasingly common within the industry, but all it takes is one brave individual to see something and stop it.
One example of hospice fraud involves the Hospice of Arizona and the American Hospice Management organization. These institutions submitted false claims over an eight-year period by billing for unnecessary care and admitting patients who didn’t qualify for treatment through Medicare, which was only discovered after a whistleblower came forward with the information. A lawsuit was filed against the two organizations, and in the end, the whistleblower was awarded $1.8 million for their assistance.
Together, We Can Protect Those in Nursing Home and Hospice Care Facilities
Our Complex Litigation Group is here for anyone who has evidence of fraudulent activity, regardless of the organization that commits it. Some whistleblowers fear that the organization they’re helping to expose will retaliate against them, but we can assure you that you’ll stay protected throughout the duration of your case. Our attorneys are well-versed in all aspects of whistleblower and qui tam litigation, allowing us to keep your involvement anonymous and your spirits high.
As a whistleblower, you could be eligible to recover 10% - 30% of the total amount recovered, and our attorneys have a proven track record of helping whistleblowers maximize that reward. If you have evidence of fraud occurring at a nursing home or hospice care center, contact us today to speak with one of our whistleblower attorneys about your best next step.