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Medicare Fraud Case Involving Hospice Settles

The Journal Sentinel reported last week on the end of a dispute between federal officials and a national hospice provider over apparent Medicare fraud charges. The involved company had been charged with billing Medicare-the government program that provides medical support to low-income and disabled Americans-for illegal charges. Specifically, according to those familiar with the situation, the company was charged with enrolling non-terminally ill patients who actually did not need hospice care. The public was then billed for this care in thousands of cases.

While discouraging, our Illinois nursing home neglect lawyers are not surprised by these allegations and this settlement. It is yet another reminder of the profit-motive that drives so many decisions at these and similar institutions. The vast majority of instances of nursing home neglect and abuse can, in one way or another, be traced back to facility owners and administrations that make decisions based on putting money in their own pockets instead of providing the best care possible to those who rely on them.

Each Illinois nursing home neglect lawyer at our firm knows that actual accountability in these situations is quite rate in the big scheme of things. Facilities continue to engage in these practices-hurting patients and bilking taxpayers-because they think they can get away with it. When those with suspicions or knowledge do not do or say anything then the companies actually do get away with it.

For example, in this case, the Medicare fraud came to light only because one former worker at the home brought her concerns to facility administrators and was then fired. The woman then brought the situation to the attention of a local attorney who was able to filed suit and work with government officials to help correct the problem. As that attorney summarized, “The real heroes of these cases are the medical professionals who stood up against the alleged fraud. The real winners in this fraud fight story are the taxpayers.”

These sorts of problems are not rare. For example, over the last year alone, the federal government recovered over $4 billion in charges fraudulent paid for by the public. On top of that nearly 1,500 people were charged with crimes as a result of that fraud. Of course, these figures only represent those cases that actually were reported. Who knows how much fraud occurs in secret.

In these “whistle-blower cases” the law actually provides incentives for those with knowledge of the Medicare fraud to come forward. Citizens in this context are allowed to sue on behalf of the government to recover lost funds. If successful, the companies may be required to pay triple the amount of money taken fraudulently. Whistle-blowers themselves get a portion of any award. This provision was inserted into the law specifically because lawmakers understood that accountability in so many of these situations hinges of the actions of private citizens. The same is true in the context of Illinois nursing home abuse and neglect. Most facilities face little penalty but for those times when individual victims of mistreatment and their families come forward and demand changes be made.

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