Government Report on Nursing Homes Finds Medicare Fraud, Patient Abuses

April 12, 2013 — In the last several years, the U.S. False Claims Act has been deployed by the U.S. Department of Justice to recoup more than $10 billion from health care providers engaged in fraudulent Medicare and Medicaid scams. The qui tam language contained in the anti-fraud statute permits whistleblowers to bring a lawsuit for the benefit of the American government and then participate in any recovery. If the United States elects to take over the lawsuit, the government collaborator receives a smaller portion of the recovery. When the Justice Department decides against intervention, the tipster is eligible to take home a greater percentage of the proceeds.

Nursing homes are frequently found to be involved in issues of health care fraud and patient neglect. A new government study by the Office of Inspector General for the U.S. Department of Health and Human Services discloses that in 2009, Medicare paid over $5 billion for patient stays in skilled nursing facilities where the care was not up to quality standards. In California, for example, state Attorney General Kamala Harris reported a settlement in February with Skilled Healthcare Group Inc. giving the state the ability to place independent monitors in 20 facilities to oversee quality of care and staffing. The previous month, Harris announced the sentencing of a nurse who drugged elderly patients with powerful antipsychotics just to silence them for the staff’s convenience.

In addition to the quality-of-care issues, questions were also raised about whether skilled nursing facilities routinely bill Medicare for physical therapy that is not medically necessary, according to Reuters. The report cited to one patient with a broken hip who should have been kept immobile. Instead, the facility in which he was being treated billed Medicare for “ultrahigh” levels of physical therapy for the duration of the patient’s stay.

Skilled Nursing Facility Insiders Blow the Whistle on Medicare Fraud

False Claims Act violations involving skilled nursing facilities frequently are reported by concerned insider employees more focused on patient care than corporate profits. Conscientious informants deserve to know their own rights before they collaborate with the government. With lawyers in northern and southern California, Waters & Kraus offers tipsters the experienced legal representation they need. Contact us or call our health care fraud attorneys at 800.226.9880 to discuss how we can safeguard your interests.