Healthcare fraud occurs upsettingly often in facilities with especially vulnerable patients. For this reason, nursing homes and hospices can unfortunately be easy targets for Medicare and Medicaid fraud.
Unscrupulous healthcare workers or administrators sometimes use the vulnerability of nursing home and hospice patients to overcharge for services rendered, perform unnecessary services, and even to cause permanent harm to patients in an effort to increase profits.
Since these facilities are not under as much official scrutiny as hospitals, and the patients are often unable to advocate for themselves, it is up to whistleblowers who have insight into this type of wrongdoing to expose it.
Nursing Home Whistleblower Lawsuits
Common examples of healthcare fraud that have been known to occur at nursing homes include:
- Billing for unnecessary tests and procedures
- Paying kickbacks to doctors for referring patients to the nursing home
- Receiving kickbacks, rebates, or other benefits for prescribing drugs or using medical devices
In one qui tam lawsuit, a former administrative assistant at a nursing home received a $405,000 reward for providing information that the facility submitted false claims to Medicare and Medicaid for physical, occupational, and speech therapy services. According to information provided by the whistleblower, the nursing home allegedly pressured its therapists into increasing the amount of therapy provided to patients to meet targets for Medicare revenue. The nursing home established these Medicare revenue targets without regard to its patients' individual needs for therapy, a practice which is in violation of federal law.
Nursing homes must also comply with federal and state laws in providing residents with adequate medical care and sanitary living conditions. If a nursing home is billing Medicare or Medicaid for its services and fails to comply with these standards, a whistleblower can hold the nursing home accountable by filing a lawsuit under the qui tam provision of the False Claims Act. These types of cases often involve allegations that a nursing home committed one or a combination of the following health and safety violations:
- Failure to meet minimum staffing requirements
- Failure to provide a clean and sanitary environment for patients
- Failure to administer medications or therapies that have been prescribed and billed to Medicare or Medicaid
- Administration of dangerous medications to patients without the patients' knowledge or consent
- Failure to regularly move patients so that they do not develop bed sores
Qui Tam Lawsuits Against Hospices
Whistleblower lawsuits against hospices often involve a facility that admits patients who do not meet Medicare eligibility requirements, submits false claims for “crisis care” services that were not necessary or not provided, or provides services that were not performed in accordance with Medicare's requirements.
For example, a whistleblower received a $1.8 million reward for providing information that the Hospice of Arizona and American Hospice Management submitted false Medicare claims over an eight-year period by billing for unnecessary care and admitting residents who were ineligible for treatment under Medicare. In this case, the hospice allegedly had policies and procedures in place that delayed and discouraged the hospice staff from discharging patients when they were no longer appropriate to be receiving hospice services. Furthermore, the hospice allegedly pressured staff to find more patients eligible for Medicare.
If you work for or previously worked for a nursing home or hospice, and have knowledge of possible healthcare fraud, contact us confidentially today. Our team of qui tam experts will review your claim free of charge and help you explore your eligibility for a whistleblower lawsuit.