In this video we will look at false claims act lawsuits against nursing homes based on fraudulent billing practices. If you have evidence that a nursing home is engaging in fraudulent practices, you can bring a whistleblower lawsuit and get a percentage of any money awarded in the case.
Under a federal law called the False Claims Act (FCA), companies that receive money from the federal government can be subject to civil liability if they obtain that federal money through fraud or false pretenses. The FCA authorizes private citizens with knowledge of fraud to act as whistleblower plaintiffs and file suit on behalf of the federal government. If the case is successful the whistleblower plaintiff gets to keep up to 30% of whatever money is awarded.
Nursing homes a significant amount of their revenues from the federal government through Medicaid and medicare. This means that nursing homes can be liable under the FCA if a whistleblower plaintiff can show that the facility received federal funds improperly. There are basically 2 categories of nursing home liability under the FCA: (1) fraudulent billing; and (2) inadequate care.
In this video we will focus on whistleblower nursing home cases involving fraudulent billing practices. Fraudulent billing by nursing homes involves any deliberate scheme to obtain reimbursement that the facility is not legally entitled to through deception or false pretenses. Nursing home billing fraud can come in many varieties and circumstances but we will look at the most common types.
Upcoding is probably the most common fraud in nursing home billing. Upcoding occurs when the nursing home bills medicare for a more expensive treatment or service than the one that was actually provided. An example of upcoding would be billing for a 1 hour consultation when the doctors only performs a 10 minute follow up.
Phantom billing is another fraud scheme at nursing homes in which the facility bills Medicare and Medicaid for patient treatments or services that were never actually provided to the patient. Other fraud schemes include performing services or treatments on patients that are not medically necessary and receiving illegal kickbacks for patient or service referrals.
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.