About a third of Americans who make it to their 65th birthdays will need nursing home care, according to the U.S. Department of Health and Human Services. In 2021, Medicare spent $92.6 billion on skilled nursing facility care and home health services.
Unfortunately, fraud is particularly problematic in nursing homes, where vulnerable patients live away from loved ones. When care is motivated by financial gain, it also puts patients’ lives at risk.
Both the state and federal governments rely on whistleblowers to report these instances of abuse and fraud. New cases describing new schemes are reported weekly.
Just this month, multiple settlements were announced related to skilled care across the country.
- On June 6, five people were arrested in Los Angeles on criminal charges tied to alleged operation of sham hospice companies that defrauded Medicare of more than $15 million.
- A long-term care management company from Massachusetts reached a $4 million settlement over allegations that it deliberately neglected to properly staff its nursing homes, causing harm and neglect to residents.
- A Georgia hospice facility will pay $1.4 million to resolve allegations of a kickback scheme to get more patient referrals.
- A Connecticut company and its CEO will pay $4.6 million to resolve allegations of fraudulently and improperly submitting claims tied to telehealth services for nursing home residents.
And in May, a California-based nursing home chain reportedly settled a Medicare fraud lawsuit for $7 million.
Whistleblower laws such as the False Claims Act empower even a single principled healthcare worker to dismantle wide-ranging frauds. Generally, healthcare fraud involves deception to get paid by an insurer — in this case, often Medicare or Medicaid — for medical goods or services. It also can involve knowingly doing prohibited things, such as paying for patient referrals, while participating in a government healthcare program.
The U.S. Department of Health and Human Services Office of the Inspector General earlier this year outlined a series of key goals in its nursing home oversight:
- To protect residents from fraud, abuse and neglect, and to promote high-quality care.
- To promote emergency preparedness and response efforts.
- To strengthen frontline oversight.
- To support federal monitoring of nursing homes to mitigate risks to residents.
Help address these problems and protect older Americans and their loved ones. If you suspect fraud or other abuses and want advice, Keller Grover’s experienced attorneys offer free and confidential consultations.