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Nursing Home Medicare Fraud Sparks Lawsuit

When a case of nursing home neglect or abuse pops up in the local news, it is natural for residents across Chicago and throughout Illinois to feel sympathy for the individual family suffering as a result of mistreatment. This conduct is always tragic and a reminder of the need to act prudently to ensure your own senior loved ones are receiving the basic care to which all should be entitled.

But in reality, community members have much more reason to be angered every time that they read these stories, beyond just basic empathy. That’s because in most case all of us are paying for the care provided.

The high cost of skilled nursing care means that many seniors who need it are unable to pay the tens of thousands (and sometimes hundreds of thousands) of dollars a year for it. Instead, they often rely on the Medicare and Medicaid programs to support their stay. For most local nursing homes, a clear majority of their revenue comes from these public sources. That is why if a facility is at risk of losing the ability to participate in the program it often means the entire home must be shut down. Most facilities cannot function without taking patients using public support programs.

This intersection between nursing home care, public funds, and lawsuits is a common theme in many nursing home abuse and neglect cases. Considering the taxpayers foot the bill, it is also something that has direct relevance for all of us–even those without loved ones in a home.

Medicare Fraud Lawsuit
These issues often spawn complex legal cases. For example, the Des Moines Register reported this week on a lawsuit between a nursing home and its billing contractor after the home was hit with steep penalties for taking Medicare funds. The main problem was that federal investigators found that various physical, occupational, and speech therapy services were billed to Medicare illegally.

The nursing home in question hired a third-party company to provide those services to their residents. However, according to federal investigators, the billing for that care rose starkly as soon as the company took over. More specifically, there was a large upswing in the number of residents undergoing an “ultra high” level of rehabilitation that was paid for by Medicare. This “ultra high” care is far more expensive than other treatments, and this home apparently had billings for these services at seven times the state average.

Both the nursing home and the rehabilitation company benefitted financially from this arrangement. The story notes that the nursing home’s profit jumped by 377% in a single year. There were allegations that the rehabilitation clinic and the skilled nursing facility collaborated to increase use of services unnecessarily for their own financial gain. However,the latest lawsuit between the companies suggests that the nursing home believes the rehabilitation center was at fault for the overbilling. The long-term care facility is seeking restitution for the funds that it lost as a result of subsequent settlement in the Medicare fraud case.

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