When a culture at a nursing home is focused entirely on maximizing profit then the perverse incentives can have damaging implications for all those working and living there. Nursing home neglect and abuse is far more prevalent at homes that have a track record of providing the lowest quality care to the seniors who depend on them. But not only are owners and administrators willing to sacrifice the safety of residents, they are sometimes also willing to blatantly run afoul of the civil and criminal law.
For example, the Star Tribune reported last week on the latest news in a new whistleblower lawsuit against one of the nation’s largest nursing home chains. A federal judge ruled that the case can proceed after defense lawyers tried to get it thrown out of court early. The heart of the suit alleges that the nursing home chain submitted false claims to Medicare and Medicaid. The suit was initiated by a former occupational therapist at one of the facilities. Considering the way that many of these facilities are willing to risk resident safety in pursuit of profit, our Illinois nursing home neglect lawyers are not all that surprised when these allegations are made.
The defendant company runs rehabilitation services at more than a thousand facilities across the country, in thirty seven states. In addition, they operate nearly 350 skilled nursing homes and assisted-living centers. According to claims made in this lawsuit, the company billed the government programs for therapy services that were never actually provided. In fact, the whistleblower who first brought the problem forward explained that therapists would often negotiate about who would claim to have provided what each day in order to meet the company’s “productivity” goals.
More specifically, the claims allege that the company fraud occurred in several forms. First, it billed unskilled, unsupervised activities as “therapy.” Second, the company billed for group therapy that did not qualify for Medicare or Medicaid reimbursement. In other situations, the therapists were urged to schedule as much therapy as possible to increase revenues. The push for extra, unnecessary therapy not only cost taxpayers but may actually have been so intense that it hurt patients.
The lawsuit is still in its earliest stages, so it is unclear how it will develop. Our nursing home neglect lawyers understand that at an initial level, it is yet to be determined if the case will include only those facilities where the whistleblower worked or all of the nursing homes chain’s hundreds of facilities nationwide. Determining the scope of the suit will have huge implications. There may be several hundred thousand dollars at stake if limited to the few facilities where the plaintiff was personally involved. However, if allowed to dig deeper into services provided nationwide, the Medicare and Medicaid fraud suit could implicate hundreds of millions of dollars. No matter what the outcome, hopefully the suit acts as a reminder to all facilities that they cannot cut corners when it comes to providing the care to seniors at these facilities that the law demands. With each lawsuit that holds the home accountable, the tone is set that encourages other facilities to comply with the law or risk serious financial penalty.
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