When poor (or unnecessary) care is provided to seniors at long-term care facilities, it is not just senior and their loved ones who suffer. The truth is that all taxpayers are taken advantage of in those situations. The vast majority of elder care is paid for via Medicare and Medicaid funds. That means that all of us actually contribute to the payment for long-term care. When that care is substandard–or we are paying for services that aren’t actually needed–then all of us have a personal stake.
Considering that public budgets are stretched to the max, and significant cost cutting is always on the table, it is absolutely critical that unlawful billing of Medicare and Medicaid funds be addressed. That is exactly what federal officials intended when they passed the False Claims Act. The law includes qui tam provisions–also known as “whistleblower” provisions. Essentially, this means that there are incentives for those with knowledge of misspent funds at these facilities to come forward. The individuals who provide information ultimately receive a portion of the recovery of misspent funds via either a settlement or successful lawsuit.
Officials recently released information on one such settlement involving a skilled nursing facility that allegedly submitted false claims for therapy services. Essentially, suit was filed against the nursing home, claiming that over a three year period the facility billed Medicare (and received taxpayer funds) for services that were not necessary. Those services included speech, occupational, and physical therapy. The lawsuit suggests that in different cases the therapy was excessive, redundant and without “clear goals or direction.”
Most elder abuse focuses on caregivers who cut corners and do not provide the full care necessary. So why are caregivers in these situations providing excessive care? As is easy to guess: money. Hiring more staff members who ensure residents do not develop bed sores or to prevent falls is a cost on the facility. However, providing certain therapy–even when not needed–may be a net gain for the facility, because they can bill out for those services.
In this case a settlement was reached with the facility. They agreed to pay back $700,000 in billings that were unnecessary and violated federal laws. All told, using tools outlined in the False Claims Act, the U.S. Justice Department has been able to recover over $14 billion in funds for taxpayers in just the last few years alone.
Employees & Service Providers Come Forward
One of the biggest challenges to ensuring proper spending and billing in these situations is having systems in place to actually catch wrongdoers. It is one thing to have a law that forbids unnecessary therapies, but it is another to be able to identify all cases where the therapy wasn’t needed. Considering the hundreds of thousands of individual cases, it may seem impossible to provide appropriate oversight.
That is where “whistleblower” provisions come in. Built into the law is a tool that allows those who come forward with information about the specifics of violations to earn a portion of the amount recovered. For example, in this case the lawsuit itself was actually filed by three former therapists at the care facility. Two of the therapists worked full time for the facility while the third was contracting to provide support. Because of their position, these employees were able to identify unnecessary therapy first-hand. They each received $122, 500 for their role in bringing the claim forward. If you may have similar information of possible fraud please contact our attorneys today to see how we can help.
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