Nursing Home Fraud Whistleblower

Nursing Home Fraud Whistleblower | Nursing Homes Healthcare Fraud, Nursing Home Medicare and Medicaid Fraud

Whistleblower Lawsuit, Whistleblower Act, Whistleblower Protection, Whistleblower Law | Nursing Home Fraud Whistleblower | Nursing Homes Healthcare Fraud, Nursing Home Medicare Fraud, Nursing Home Medicaid Fraud | Nursing Home Fraud Whistleblower Lawyer, Attorney, Lawsuits

Nursing-Home-Fraud-WhistleblowerNursing homes receive a substantial amount of revenue from Medicare and Medicaid. Some unscrupulous nursing homes and long-term care facilities have engaged in healthcare fraud in order to inflate their Medicare and Medicaid reimbursements. In some cases, facilities have billed government healthcare programs for unnecessary procedures and testing, and improperly classified residents to maximize reimbursements. Nursing homes can also be prosecuted for healthcare fraud if they are found to have accepted kickbacks in return for referrals, or for using a company’s drugs or medical devices.

Whistleblower lawsuits are an extremely effective way of combating nursing home healthcare fraud. If you have first-hand knowledge that a nursing home engaged in such fraud, you may be eligible to file a whistleblower lawsuit on behalf of the U.S. government. The False Claims Act allows whistleblowers to receive anywhere from 15-30 percent of the government’s recovery in a qui tam lawsuit, and protects nursing home whistleblowers from retaliation for reporting fraud.

Billing for Unnecessary Tests and Procedures

One of the most common types of nursing home healthcare fraud, and involves administering tests and treatments to residents that are not medically necessary. This practice not only costs taxpayers millions of dollars each year, but subjecting a patient to unnecessary medical procedures can cause them substantial harm.  Healthcare workers in long-term care facilities and family members of nursing home residents should pay particular attention to the services being provided to patients.  If bills are inflated for services that a patient does not need, or if they overstate the services being provided, the nursing home could be violating the Fair Claims Act. 

Illegal Nursing Home Kickbacks

Pharmaceutical companies, medical device manufacturers, laboratories, ambulance company, testing facilities and other providers are legally barred from paying nursing homes kickbacks for using their products or services. Federal law further prohibits anyone from making or accepting payments to, or rewarding anyone for referring, recommending, or arranging for the purchase of items being paid for by federally funded programs. This practice usually results in unnecessary services being performed to generate additional income to pay the kickbacks. For example, kickbacks offered by pharmaceutical companies can result in patients being treated with unneeded prescription drugs that have the potential to cause serious side effects.

Misclassifying Nursing Home Patients

Medicare has established a per diem Prospective Payment System (PPS) for skilled nursing facilities to determine a reimbursement rate for each resident. Medicare-certified nursing homes must assess residents’ needs using the Minimum Data Set (MDS) tool. Using MDS information, Medicare then assigns one of seven categories to each patient using a computer program called the RUG III Grouper. The category in which a nursing home resident is placed will determine the Medicare per diem reimbursement rate for that individual. Some nursing homes have been prosecuted for altering or falsifying MDS information in order to improperly place residents in higher reimbursement classifications.

Learn More about Filing a Nursing Home Fraud Whistleblower Lawsuit, Or About The Whistleblower Act, Whistleblower Law, and/or Whistleblower Protection

If you are considering becoming a nursing home fraud whistleblower, Alonso Krangle LLP can help. We offer free nursing home fraud whistleblower lawsuit evaluations to potential False Claims Act whistleblowers. Our whistleblower lawyers will review your case in detail, and ensure you comply with the detailed requirements of the False Claims Act. For more information, please fill out our online form or call 1-800-403-6191 today.