July 30, 2015

Miami Nursing Home Settles over Alleged Kickback Scheme

by Levin & Perconti

False Claims and Kickbacks

We have continuously seen the importance of whistleblowers in the world of healthcare, and specifically in nursing homes and long-term care facilities. The government typically uses the False Claims Act and the Anti-Kickback Statute to go after such fraud. These laws are implicated where healthcare providers make claims for reimbursement of services to patients and residents insured by federally funded Medicare and Medicaid, yet those claims are for fake services, or consist of overbilling.

They are also implicated where healthcare providers provide kickbacks for referrals of business, such as for prescription drugs, or for patient referrals. These types of activities are illegal. Sometimes insiders at companies or medical providers, who are privy to the illegal activity, can aid the government by reporting it. These whistleblowers not only do a good thing, but can stand to benefit financially, as the False Claims Act provides for whistleblowers to receive a certain percentage of the financial recovery. This rewards their participation, which can be stressful and put their own careers in jeopardy, as well as incentivizes others to come forward.

Kickback Scheme

In Miami, a nursing home agreed to a substantial settlement with the U.S. Department of Justice to pay $17 million over allegations that the company made kickbacks in violation of federal law. The Hebrew Homes nursing home was accused of making financial kickbacks to doctors and medical directors in exchange for making patient referrals. The kickbacks were orchestrated as contractual salaries for these individuals even though their positions did not truly exist at the nursing home. Rather, the home simply paid doctors to send patients to the facility. Such payments in exchange for referrals amount to kickbacks which is illegal. Where federal funds are involved because medical providers (like nursing homes) have patients insured by Medicare or Medicaid, which are federally funded programs, making such claims for reimbursement for these “fake doctors” amount to false claims against the government and a basic theft of taxpayer funds.

In addition to fraud on the government and taxpayers, it is also a terrible affront to patients and facility residents, since Medicare and Medicaid funds should be spent on their care, rather than in a scheme to gain more business. Such fraud can lead to civil and/or criminal prosecution. As with many settlements, the nursing home in this case did not admit liability. It was also reported that in addition to the settlement with DOJ, the nursing home operator also came to an agreement with the U.S. Department of Health and Human Service’s Office of Inspector General to reform its policies to ensure this does not happen again.

Whistleblower started it all

The nursing home company’s chief financial officer was the tipster that alerted the government to the kickback scheme. Under the False Claims Act, individuals can themselves bring a lawsuit on behalf of the U.S. government. This is known as a “qui tam” action. The Department of Justice can then elect to participate as plaintiff, which it did in this case. As a result of the CFO’s participation, he will reportedly earn over $4 million. This case overall demonstrates the importance of enforcing the false claims and kickback laws, as well as the importance of insiders as whistleblowers to root out fraud.

See Other Blog Posts:

Massive Medicare Fraud Takedowns

Medicaid Fraud Units Also Target Abuse and Neglect

July 28, 2015

Beware Online Scams against Seniors

by Levin & Perconti

By now, many of us hear horror stories about the hacking of emails, government agency servers, company servers, and the theft of personal information. The recent attacks on the federal government’s Office of Personnel Management’s servers potentially exposed the personal information of about 21.5 million individuals who worked for or may have only applied for jobs within the federal government. Many of us all know the years-old comical story of emails from a mysterious (and fictitious) Nigerian prince seeking financial help.

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July 26, 2015

Abuse at Nursing Home while Bystanders Do Nothing

by Levin & Perconti

In New Hope, Minnesota, two nursing home residents suffered horrendous maltreatment at the hands of at least a pair of facility employees. At the Saint Therese Senior Care Facility, two nursing assistants are alleged to have abused two residents at the facility. Not only have they been fired, but they were arrested and booked, though no criminal charges have yet been brought. To date it has not been entirely revealed what occurred, but the state’s Department of Health is investigating the matter while the city attorney awaits further information in order to make a decision as to whether or not the city should file criminal charges against the workers. This case, albeit in the investigatory stages and lacking clear details, is another reminder of how abuse and neglect can land alleged perpetrators in hot water, and cause tremendous problems for facilities in terms of their own possible sanctions, charges, and loss of reputation and business.

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July 24, 2015

Doctor Gives Bogus Cancer Treatments, Bills Medicare, Goes to Jail

by Levin & Perconti

Healthcare Fraud in General

Various types of fraud occur across the healthcare industry. The most common types we see in the headlines concern Medicare and Medicaid fraud. Medicare and Medicaid are federal programs that fund and administer, in conjunction with relevant state health agencies, to insure the elderly and poor for healthcare. This can cover, in whole or in part, doctor visits, hospital stays, and even residency at nursing homes and long-term care facilities. Healthcare providers who falsely bill or overbill for services not rendered, or prescribe treatments or procedures that are unnecessary and then bill Medicare and Medicaid for reimbursement, commit fraud against the government and thereby the taxpayers. This activity is sometimes tied into kickbacks schemes whereby providers receive kickbacks for making patient referrals or using specific pharmaceutical drugs, which is generally illegal.

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July 21, 2015

Collecting Money From Your Judgment

by Levin & Perconti

In our society, people often say, “You should sue him,” when a business deal goes wrong, or when someone suffers a personal injury or property damage. But suing someone, and even winning, is only the first half of the process. The second half, and often the hardest part, is collecting on the judgment award and actually receiving money for the harm caused.

Collecting A Judgment in Illinois

The process of collecting on a judgment starts with learning what assets the debtor owns. Typically, there are four main sources of money that a creditor can look to for money from an individual debtor, including (1) the debtor’s bank accounts; (2) the debtor’s personal property; (3) the debtor’s paycheck; and (4) the debtor’s real property.

Citation To Discover Assets

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July 18, 2015

Your Time Is Running Out: The Illinois Statute of Limitations

by Levin & Perconti

It’s heartbreaking to take a call from someone who was seriously hurt in an accident – whether a car accident, truck accident, motorcycle accident, etc. – and you have to tell them that the statute of limitations expired and you can’t do anything for them. It’s a harsh reality - you don’t have an infinite amount of time to take action against the party that hurt you.

In Illinois, you have two years from the date of the injury to file a personal injury lawsuit. Yes, that means the statute of limitations may begin to run the day you get injured. Though, the statute of limitations might run from the date you discovered you were injured, rather than the date that you actually suffered the injury. This is known as a "discovery date" and typically comes into play with workplace disease claims and medical malpractice claims. Typically, if you were hurt in an accident, the statute of limitations begins to run on the date of the accident.

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July 16, 2015

Who is the Plaintiff, and Who Gets the Award in a Wrongful Death Case?

by Levin & Perconti

It may not be as clear as you think.

When negligence results in death, the law has a couple ways of compensating for the loss. First, if the person did not die immediately, her estate might choose to bring a survival action. Second, the person’s family might choose to bring a lawsuit based on their own loss. After all, the death of a spouse, parent, or child can have a lasting and devastating impact on the family, not only emotionally, but also financially. These are called wrongful death actions. Many cases involve claims for both.

Clients often come to an attorney consumed by grief. Perhaps the client just lost a spouse or elderly parent. The deceased person may have children by more than one marriage. There may even be a will. Close family members often assume that as a spouse or child, they will receive the full sum of the court’s award. Likewise, they might have heard that the will determines who gets the money. But it is not always that easy.

Survival v. Wrongful Death

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July 14, 2015

Resident Abuse Caught on Camera

by Levin & Perconti

Out of the Far Rockaway neighborhood of Queens, New York comes an incredibly sad tale of alleged horrid abuse committed by nursing home workers against their residents. According to local reports, back in October 2014, three employees of the Peninsula nursing and Rehabilitation Center – two nurses and a certified nurse’s aide – were implicated in the abuse. One of the nurses pulled a middle-aged male patient around on the floor while other employees merely watched.

The scene is described as the man bled from around his arm or neck, and was clearly in pain. He was allegedly left on the floor for about 12 minutes, though which had to have felt like eternity, and then was dragged all the way back to his room. Reports also indicate that the man was already seriously debilitated both physically and mentally. Close to another half hour later, he was bleeding from the back of his head as well as his face, while two of the staffers merely ignored him and allegedly failed to properly treat his injuries as the man crawled around back into the hallway. One of the staffers then grabbed in and again dragged him toward his room.

The nurses and nursing aide implicated in the abuse as well as the mere standing by and thus neglect to help the injured and bleeding man, all no longer work at the facility, having either been fired or resigned their positions. They have also been arrested for violating health laws and for endangerment of a disabled person, demonstrating that not only their employment status can be affected, but that they can face criminal charges for such alleged heinous behavior. All accounts are allegations at this point, and all three entered not guilty pleas. They each face up to four years behind bars if convicted.

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July 10, 2015

More Reports of Nursing Home Sexual Abuse

by Levin & Perconti

At the end of June, reports emerged of a particularly heinous act committed at a nursing home in the state Washington. We are unfortunately all too used to seeing incidents of physical, mental and emotional abuse of nursing home residents across the country. Some residents find themselves ignored in spite of the need to be properly fed, nourished, hydrated, and bathed. This can lead to malnourishment, dehydration, and unsanitary living conditions in which they can develop bed sores or other conditions, which can then worsen into sepsis or other infections. Unfortunately we also see nurses and nursing aides and other staffers resort to physical abuse when they become impatient with a resident, or simply out of pure cruelty.

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July 7, 2015

Former Illinois Health Department Official Convicted for Kickbacks

by Levin & Perconti

The Illinois Department of Public Health is a key agency in the oversight of nursing homes and the enforcement of laws and regulations over those facilities. Thus it is only fair to expect that the officials and employees at this vital state agency are trustworthy and do what is in the best interest of the state’s citizens and residents when it comes to public health. This unfortunately cannot be said for a particular IDPH official who will be going behind bars for two years after authorities uncovered a multi-million dollar kickback scheme to take money from a federal grant program.

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July 3, 2015

Owner Makes Nursing Home Inhospitable to Push Residents Out

by Levin & Perconti

In the Prospect Park area of Brooklyn, New York, residents at the Prospect Park Residence nursing home have reportedly had to endure uncomfortable conditions, all because of the allegedly skewed priorities of the nursing home’s owner. The owner simply will not turn on the air conditioning at the facility, which undoubtedly makes for a miserable environment during the middle of another hot summer, all because he wants to push the residents to move out by making the conditions so inhospitable. There are only seven residents left to sweat out the lack of air conditioning. Apparently if everyone moves out and there are no more residents, the owner will be able to sell the facility. There had been a tentative deal in place to sell the building for $76.5 million, but on the condition that all residents move out. The owner had plans to sell since April 2014. The facility once housed 130 residents before decreasing down to the present seven. The refusal of remaining residents to move (and the refusal of their families to have the moved) has led to the real estate deal falling through.

Unsanitary and Unlivable

Local reports noted that the state Department of Health previously cited the nursing home for not correcting fire safety violations over the course of two years. The owner also failed to renew the facility’s license as required, and it was further reported that there were other problems related to sanitation and food service, leaky ceilings and peeling paint, bed bugs, and a failure to ensure residents were following restricted diets. To add insult to injury, the owner has even raised rates charged to residents.

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July 1, 2015

Governor Rauner Wants to Limit Community Care Funding

by Levin & Perconti

As we have seen, there has been a growing trend in community-based healthcare, which offers an alternative to the strictures of nursing home care. Through community-based care, patients can receive in-home visits or live-in aides to ensure that they receive the proper care, but have the freedom of being at home. This is also the case for hospital patients who, when released, can receive follow-up care at home to reduce the likelihood of having to be readmitted to the hospital with a relapse or more complications (such community-based care has been a staple of the Medicare expansion of the Patient Protection and Affordable Care Act).

With the restrictions of nursing home life, and the unfortunate incidents of abuse and neglect that can lead to illness, injury and even death, community-based has become a more attractive option for those who would be right for it. And Medicare funding and other insurance has expanded to cover the costs of such care for many in whole or in part. Illinois’ Community Care program provides visits for the elderly and infirmed to help them bathe, prepare food for them, and help them with otherwise routine chores that they cannot do or struggle to do on their own as a result of age or disability.

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