In our first video we looked at whistleblower lawsuits against nursing homes for fraudulent billing practices. In this second video, we will discuss suing a nursing home under the False Claims Act for providing inadequate patient care.
Nursing homes can be sued under the FCA if the provide negligent or inadequate care to patients at the facility. These types of FCA cases are known as “false certification” cases. Here is a basic summary of how false certification cases for inadequate care at nursing facilities work.
All federally approved nursing homes are required to comply with various regulations and rules regarding minimum levels of patient care and safety. If a facility fails to comply with these requirements, they can potentially lose their approved status and no longer be eligible for federal program payments.
Each time an elder care facility requests reimbursement from Medicaid or Medicare, the facility must certify that it is fully compliant with all applicable regulations regarding patient care and safety. If the nursing home is blatantly ignoring those regulations but certifying that they are in compliance for the purposes of receiving, that is considered fraud. The facility is basically making a false claim in order to get money from the federal government. This is exactly the type of fraudulent conduct that whistleblower lawsuits can be based on.
If you have direct knowledge that a nursing home is providing negligent care in violation of federal health and safety regulations, you can become a whistleblower and bring an FCA lawsuit.
Nursing homes that engage in these types of fraudulent or deceptive billing practices cost the federal government an estimate $60 billion every year. If you have inside or direct evidence of a nursing home engaging in any of these fraudulent billing practice or otherwise getting improper Medicaid or Medicare reimbursement, you can become a whistleblower and bring a FCA lawsuit.