Nursing homes are entrusted to care and look after the well-being of some of society’s most vulnerable individuals. Families place their elderly loved ones in these facilities with the expectation that they will receive the highest standard of care. Unfortunately, not all nursing homes fulfill this obligation, and in some cases, they engage in fraudulent practices that not only compromise patient care but also violate the law. Healthcare fraud cases in nursing homes is a serious issue that can lead to devastating consequences for the residents and significant legal repercussions for the facilities involved.
Healthcare fraud in nursing homes can take many forms, including overbilling, charging for services not rendered, and/or falsifying medical records. These fraudulent activities not only exploit residents and their families but also defraud government programs like Medicare and Medicaid. We will provide further insight into what to look for in regard to healthcare fraud in NY nursing homes in the following article.
However, if you suspect that a nursing home is engaging in healthcare fraud, we encourage you to seek legal help from the personal injury attorneys from Brandon J. Broderick, Attorney at Law. Our team has the experience and knowledge to help you.
Understanding Healthcare Fraud in Nursing Homes
Healthcare fraud in nursing homes can manifest in various ways, often involving complex schemes to deceive patients, families, and government agencies. Some common forms of fraud include overbilling, falsifying records and more.
Common Forms of Healthcare Fraud
Overbilling and Upcoding
Nursing homes may charge for services that were not provided or bill for a higher level of care than was actually delivered. This practice, known as upcoding, is a common form of fraud that inflates the facility's reimbursement from Medicare or Medicaid.
Billing for Unnecessary Services
Facilities may perform and bill for unnecessary medical procedures or tests solely to increase their revenue, without regard for the patient's health or well-being.
Falsifying Records
Nursing homes may falsify patient records to justify billing for services not provided or to cover up inadequate care. This can include altering treatment records, forging signatures, or creating fake documents.
Kickbacks and Referrals
Some nursing homes engage in illegal kickback schemes, where they receive financial incentives for referring patients to certain providers or for using specific medical equipment or pharmaceuticals.
The Impact on Patients and Families
Healthcare fraud in nursing homes extends beyond financial loss. When nursing homes prioritize profit over patient care, it impacts residents who can suffer from neglect, inadequate treatment, and even abuse. Families who trust these facilities with their loved ones' care may feel betrayed and helpless, especially when the fraud results in harm to their family members.
In addition to the emotional toll, healthcare fraud can lead to legal and financial challenges for families. Overbilling and other fraudulent practices can drain a family's resources and complicate their ability to obtain necessary medical care for their loved ones.
Legal Implications for Nursing Homes Engaging in Fraud
Nursing homes that engage in healthcare fraud face serious legal consequences under both federal and state laws. The primary federal statutes used to combat healthcare fraud include the False Claims Act, the Anti-Kickback Statute, and the Stark Law.
False Claims Act
The False Claims Act (FCA) is a federal law that allows the government to pursue legal action against entities that submit false or fraudulent claims for payment to government programs like Medicare and Medicaid. Under the FCA, nursing homes that engage in fraudulent billing practices can be held liable for treble damages (three times the amount of the fraudulent claims) and substantial civil penalties.
Anti-Kickback Statute
The Anti-Kickback Statute prohibits the exchange of anything of value to induce or reward referrals for services covered by federally funded healthcare programs. Nursing homes that engage in illegal kickback schemes can face criminal charges, fines, and exclusion from Medicare and Medicaid.
Stark Law
The Stark Law, also known as the Physician Self-Referral Law, prohibits physicians from referring patients to entities with which they have a financial relationship for certain designated health services paid for by Medicare. Nursing homes involved in violations of the Stark Law can face significant financial penalties.
Whistleblower Protections
Whistleblowers play a critical role in uncovering healthcare fraud in nursing homes. Under the False Claims Act, individuals who report fraudulent activities (known as "relators") can file a qui tam lawsuit on behalf of the government. If the lawsuit is successful, the whistleblower may be entitled to a portion of the recovered funds as a reward.
Civil and Criminal Penalties
Nursing homes found guilty of healthcare fraud can face both civil and criminal penalties. Civil penalties may include fines, repayment of fraudulent claims, and exclusion from participating in Medicare and Medicaid. Criminal penalties can include imprisonment for individuals involved in the fraud, as well as additional fines and sanctions against the facility.
Pursuing a Legal Claim Against a Nursing Home
If you suspect that a nursing home is engaging in healthcare fraud, it is important to take action to protect your loved one and hold the facility accountable. The first step is to gather evidence and documentation that supports your claim, and seek legal help.
Consulting with an experienced attorney will ensure you have expert guidance and support in your healthcare fraud case. An attorney can help you understand your legal options, file a claim under the False Claims Act, and represent your interests in court. They will also ensure you do not miss any deadlines to file a claim.
Need Legal Help? Brandon J. Broderick, Attorney at Law is One Phone Call Away
Navigating a healthcare fraud case in New York can be challenging. Fortunately, you don't need to do it alone. The experienced personal injury lawyers at Brandon J. Broderick, Attorney at Law, are available 24/7 to help you understand your legal options, gather necessary evidence, and build a strong case to secure the settlement you deserve.
Contact us now for a free legal review.