As the COVID-19 pandemic accelerated around the world in March 2020, it was easy to miss an important announcement from the United States Department of Justice. As part of a pledge to help and provide hope to elderly Americans, Attorney General Barr “announced the launch of the department’s National Nursing Home Initiative.” This is “a comprehensive Department of Justice effort, led by the Elder Justice Initiative and in strong partnership with the U.S. Department of Health and Human Services” to use “every available tool to pursue nursing homes that provide grossly-substandard care to their residents.” DOJ’s announcement is an important step to address a problem that preys on our elderly, and steals taxpayer money in the process.
How Big is the Nursing Home Industry?
According to Center for Disease Control and Prevention statistics from 2016, there are approximately 15,600 nursing homes in the United States with nearly 70% of them owned and operated by for-profit entities. Collectively these nursing homes have 1.7 million licensed beds, and as many as 1.3 million Americans reside in these facilities. As the Baby Boom generation ages, more and more Americans rely on nursing homes for care of their elderly family members.
Medicare reports that it spends more than $166 Billion for freestanding nursing care facilities and continuing care retirement communities. In addition, the Congressional Budget Office reports that as much as 15% of the Medicaid budget goes to nursing home care and other services for the elderly. With this kind of money at issue, the potential for fraud is real – and growing.
What Kinds of Fraud Happen In Nursing Homes?
As the DOJ’s new priority makes clear, “grossly sub-standard care” is one of the ways fraud happens. Facilities that are reimbursed to provide vulnerable seniors a safe and healthy environment to convalesce or live fail to deliver those basic services. But these are not the only ways that unscrupulous individuals and corporations use nursing homes and their elderly charges to unlawfully profit off the federal government.
Other schemes commonly associated with nursing home fraud include billing for goods or services not provided, billing for “phantom” patients who don’t actually exist, double billing, billing for more expensive procedures than were actually performed, billing for unnecessary services, billing for goods or services that are not reimbursable, engaging in kickbacks to secure patients, and improperly recruiting or enrolling patients or residents.
Each of these schemes impacts the quality of care for this vulnerable population while consuming scarce government resources when we need taxpayer funds to support more and more elderly Americans.
How Can You Help?
Practically speaking, the government cannot be in every one of the 15,600 nursing homes in the United States, and frauds happen behind closed doors. This is especially true since the COVID pandemic took off in this country and nursing homes were placed in lockdown for the protection of the elderly in them. Now no one on the outside is able to see what is happening inside these facilities. If fraud was difficult to detect before 2020, it is even more difficult in the COVID era. If you have information about a fraud occurring in a nursing home, please call us or fill out the form below for a free and confidential consultation.
Who we are
Keller Grover LLP
Whistleblower cases require lawyers litigating them to prove a fraud while protecting their client who typically learns of the fraud at work. While many law firms have experience dealing with fraud cases or employment issues, few are experienced enough to handle both issues together. The lawyers at Keller Grover have over 30 years of experience litigating both fraud and employment matters, and more than a decade of experience litigating cases involving violations of the federal False Claims Act and the state equivalents. We have secured groundbreaking decisions interpreting these laws on numerous issues relevant to all whistleblowers. We are also regularly featured speakers on all aspects of our law practice to audiences including other qui tam lawyers and government lawyers. We have secured judgments totaling tens of millions in recovery to taxpayers. This rare combination makes Keller Grover uniquely qualified to represent whistleblowers.
Contact Us
If you have information about a fraud involving nursing homes, please call us or fill out the form below for a free and confidential consultation.